Choose and find a wide variety of public health and safety articles we have collected for you » Men’s Health-Erectile Dysfunction

CONTRACEPTION AFTER CHILDBIRTH – THE IMMEDIATE PUERPERIUM

admin — Tue, 07 Apr 2009 07:25:12 +0000

The joy, happiness and sense of achievement in the birth of the baby may be inhibited by recent memories of traumatic delivery, a painful perineum, difficulties with breast feeding or postnatal depression. Sexual matters seem an irrelevance. Several studies have shown that women experience a marked reduction in sexual activity and enjoyment in the third trimester and for up to three months postpartum. This may be nature’s way of ensuring the maximum preservation of the infant by giving it the mother’s undivided attention during the most vulnerable period of its life. Such a view is borne out by the tradition of primitive societies that the newly delivered woman remains with the other women until the baby is seen to thrive. In some races and some religions sexual intercourse is forbidden until the lochia ceases, or while breast feeding continues, although these tend by inference to be polygamous societies.

*161/197/1*

THE SECOND BABY – INTRODUCTION

admin — Tue, 07 Apr 2009 07:18:57 +0000

Many couples who have had problems conceiving their first baby have found no trouble in becoming pregnant for a second or subsequent time. But what about the agony of those whose second baby does not materialize? The women themselves often say, ‘I suppose I shouldn’t be making such a fuss because I am so lucky to have one baby.’ For those setting up infertility self-help groups, one of the first questions always seems to be, ‘Do we have separate groups for those with and without children?’ Couples with trouble conceiving a second child are certainly not recognized in the statistic which says that only 4% of women remain involuntarily childless at the menopause, but fortunately they have been included in Hull’s figures of one in six couples seeking help for infertility at some stage in their lives (Hull, Glazener, Kelly et al., 1985).

The reliance on the efficacy of birth control is so great that a woman’s expectation of control over her own reproductive capacity is equally high. When contraception, pregnancy and contraception again have followed in an easy sequence, the non-occurrence of the expected pregnancy comes as a great shock.

*124/197/1*

COUNSELLING THE PATIENT WITH THE UNPLANNED PREGNANCY – DEPENDENT WOMAN

admin — Tue, 07 Apr 2009 07:12:29 +0000

Difficulties may arise from the fact that other people are nearly always involved. If a woman is to have a baby, she is likely to become dependent on those around her and the influence of husband, boyfriend or parents is likely to have an important bearing on her decision, even if she chooses in the end to defy them. It is a brave woman indeed who decides to go ahead with a pregnancy totally unsupported, or to have an abortion if that is against the ethics of the people she most loves and would risk losing. Sometimes the picture is so dominated or confused by others that it can be difficult for the woman to sort out her own feelings. This is particularly so with the very young who are still emotionally and physically dependent on their parents, and where the maternal grandmother would often have greatest responsibility in rearing the baby.

Miss E. was aged 1 5 and was brought to the clinic by her mother. Mother appeared to be a caring woman who felt it would ruin her daughter’s life to have a baby, but she was also concerned because she herself worked full-time and a new baby in the house would be a major disruption. Miss E. sat sullenly and said very little. The doctor asked her mother to leave the room while she examined the patient and tried with little success to find out what her real feelings were. She felt very aware of the generation gap, but an abortion did seem for the best so arrangements were made. Miss E. went in to see the nurses to arrange for her admission. Only then did she say she wanted the baby. The nurse did not book her in but suggested she think things out and come back the following week. She came back this time by herself. She wanted the abortion as she wanted to carry on at school. She had made her own decision now.

*87/197/1*

CARE OF THE YOUNGER PATIENT – HOW SHOULD ‘YOUNGER’ BE DEFINED WHEN CONSIDERING PATIENTS SEEKING CONTRACEPTION?

admin — Tue, 07 Apr 2009 07:03:53 +0000

Should it be by chronological age or by sexual and emotional maturity? If the latter is the yardstick, then the younger patient may be 13 or 30. The emotional tasks of adolescence, and the normal ages at which they are accomplished, have been described by Christopher (1992). The degree of emotional maturity, and the speed with which it is reached, varies widely between individuals, so that the professional offering help needs to be constantly aware that a consideration of the actual age of the patient is not enough to understand the emotional, sexual and contraceptive needs and difficulties.

For the main body of this chapter, the younger patient will be taken to mean the teenager or adolescent. Among these, doctors will see very few who are under 15 years old. These very young girls will be dealt with separately at the end of the chapter. It is estimated that 18 000 15-year-old girls took formal advice on contraception in 1990 in England. In total, all those under 16 years comprise less than 4% of the total workload of what is regarded as a young person’s clinic in a large city (Brook Advisory Centre, 1990). However, they are an important group, not only in terms of health care in its widest sense, but because they fall into a special category as regards legal and ethical considerations.

*50/197/1*

THE IMPORTANCE OF MOTHERS – INTRODUCTION

admin — Tue, 07 Apr 2009 06:57:19 +0000

Girls whose own mothering has been inadequate may be very uncertain of themselves and of their sexual identity. They may have particular fears about the effect of contraception on their fertility, and they may need to establish their femininity by becoming pregnant. For some girls, once pregnancy is confirmed and the reality of coping with a baby is faced, abortion may be requested. For others, having a baby not only establishes their identity but increases their self-worth by providing someone of their own to love. Girls who have been in the care of the local authority are especially vulnerable in this respect.

Getting pregnant and having a baby is at some level both identifying with one’s own mother and also rivalling her. This can cause anxiety, both for having the temerity to attempt such competition, and also from fear of an envious attack from mother. There may be a wish to triumph over mother, to outdo her or the siblings. There may be the idealization of motherhood with consequent fear of not being so good at the job as mother had been.

*13/197/1*

KEEP YOUR POTENCY: SMOKING CAN DAMPEN YOUR FIRE

admin — Fri, 27 Mar 2009 07:54:52 +0000

It’s not just the immediate negative effects of smoking that you should worry about when you light up. The long-term results of smoking can be even worse—overtime smoking can silently sabotage your sex life.

Smokers’ arteries are harder, thicker and more clogged than those of nonsmokers. And smoking seems to mess up peripheral arteries even more than those supplying the heart That means it may be particularly bad for the arteries in you penis. Smoking can also cancel the positive effects of exercise leaving you at square one.

Our best advice: What is good for your lungs and heart is also good for your penis. So don’t smoke. If you do, stop. There are many programs that help people give up tobacco. Don’t hesitate to get help if the thought of going cold turkey make you tremble.

The Power of Potent Thinking

The most important factor in lifelong sexual success is attitude. All the information and medical advice in the world won’t help you unless you want it to. If you feel that sex is important and you want it to be a vital part of your life, chances are you’ll find a way to make it so.

Remember: About 90 percent of men with erection problems can find a solution.

*206\184\8*

THE IMPLANT SURGERY: MAKING THE CHOICE

admin — Fri, 27 Mar 2009 07:17:32 +0000

Deciding if a penile implant is right for you is a complicated personal and medical decision. Of course, your feelings are crucial. But so are your partner’s. Both of you need to have realistic expectations of what the surgery will and won’t do. The more your partner participates, voices her concerns, asks questions and gets answers, the more comfortable she is likely to be with the process—and the more satisfied with the outcome.

When doctors talk about a “good” candidate for implant surgery, they’re referring to someone who is likely to be satisfied and happy with the results, can withstand the physical and emotional stress any surgery can bring and can effectively deal with the recovery process.

Gary, for example, a 46-year-old, lost his erections to a combination of diabetes and high blood pressure medication. Unfortunately, he couldn’t change his medication and he had trouble managing his diabetes as well as he might have. A series of job and financial setbacks compounded the stress on his body and his emotions. On those rare occasions when he was able to become erect, he quickly lost potency. Five years after he first noticed any sexual problem, Gary was completely unable to have intercourse. He was, understandably, very frustrated by the situation. And he was depressed. The potency problem nagged at him, eroding his self-confidence.

Throughout this difficult period, however, he tried to remain close to his wife, Dottie. They remained physically affectionate, touching often, and continued to have sexual contact. And Gary and Dottie did several things that helped them during this stressful time: They did not blame each other for Gary’s lack of erection, and they discussed the difficulty, but they didn’t make it a point of argument. “We were very supportive of each other; we had a good relationship,” Dottie explains.

Gary had a very clear reason for getting an implant: Plain and simple, he wanted to have intercourse with Dottie. She was concerned that the operation might pose a risk to her husband’s health, but she also was eager to get their sex life back on the track.

Gary and Dottie made several visits to the doctor, and discussed the options in detail. In the end, Gary chose the inflatable implant (discussed later), partly because it was more natural in appearance and he belonged to an athletic club. “I didn’t want anyone to know I’d been impotent and had an implant.”

Now, about a year later, Gary and Dottie are quite happy with the results of his surgery. Gary is enthusiastic: “Satisfied! I could not even begin to describe it. If it broke, I’d be at the hospital tomorrow. I would get it replaced even if I had to get it done weekly!”

In a separate conversation, Dottie echoes her husband’s pleasure. “Yes, I’m pleased. Very pleased. Sex is as good as— maybe even better than—when we first married.”

Gary had several characteristics that are crucial to success. Based upon research and clinical experience, we’ve summarized the factors which make a man a good candidate for an implant. Gary had many of them. You should too before having the surgery.

*147\184\8*

ERECTILE DYSFUNCTION: WHAT TO EXPECT AT THE DOCTOR’S OFFICE

admin — Fri, 27 Mar 2009 06:57:48 +0000

In general, the doctor will start by taking your history and giving you a physical examination aimed at detecting the cause of your condition. Part of this evaluation for impotence should include checking to see if you have any underlying medical conditions which could be responsible for the problem, including diabetes, kidney disease, liver disease and blood-flow problems. If s important to check for the risk factors of heart and blood vessel disease, because erection problems can be your body’s way of signaling that your blood vessels aren’t working properly.

A workup for impotence should include:

• A complete history of your problem.

• A thorough physical examination, with special attention given to your reflexes, sensations and pulses in the leg and pelvic areas, and a good examination of your penis and testicles to check for any abnormalities.

• Blood tests to determine your testosterone (male hormone) levels.

• A complete discussion of all medications you use.

• A thorough look at your use of alcohol, cigarettes and recreational drugs.

• Sleep erection and/or penile shot tests (explained later in this chapter) to determine your physical ability to get and maintain an erection.

Depending on the results, further sophisticated nerve, blood-flow and psychological tests may be given.

*118\184\8*

SEXUAL LIFE: GOOD TALKERS MAKE GREAT LOVERS

admin — Fri, 27 Mar 2009 06:29:19 +0000

The couples that seem to come through the experience of erection problems best are the ones who keep the lines of communication open. Sometimes it takes a great effort on the part of both the husband and wife. Potency problems are potentially more destructive players in a relationship than other health problems. When the partners maintain open communication, are supportive of each other and take the attitude that “we’re going to work this thing through,” a relationship can even be strengthened by the problem. Jay and Hilda have been married three decades and have had more than their share of troubles, including financial setbacks and some serious health problems for both of them. “We’ve been through a lot together,” says Hilda, reflecting on their shared years. “The two of us, and our two sons. But we’re a special, good family. In a way I think our troubles have made us especially close. Even now we will sit around the kitchen table and just talk things out.”

Jay is a plain spoken man who had to quit school at an early age to go to work to support his family. Now nearly ready to retire, he regrets his lack of education and the fact that he’s labored at factory jobs all of his life. But he takes great pride in the fact that he’s always supported his family and managed to help put his two sons through college. Jay is also a man who always had a strong sex drive, and he and Hilda count sex as one of the great pleasures in their lives.

“My goal has always been to satisfy my wife,” he says. “Our communication is excellent. After all, what’s good for her is good for me.”

“We always had a good sex life,” Hilda concurs.

Several years ago, Jay suffered a series of health problems. He had major surgery several times, including a prostate operation. Unfortunately, Jay’s doctor gave him little advice or information about the possible changes the surgery and the major stress on his system from the different operations could bring. As far as sex goes, “He just said use it or lose it,” recalls Hilda.

Once Jay recovered from his health problems, he was eager to resume relations with his wife. But he couldn’t keep an erection. “I had a lot of stress in my life, still,” he says. “I had two kids in college, and Hilda has a chronic illness which sometimes flares up.” So, at first, Jay attributed his erection problems to these very real pressures.

But when the problem persisted, it began to take its toll. “The way it happened, my husband decided he wasn’t interested in sex. This was a big change! He was always the one to initiate sex,” Hilda says. “But he couldn’t maintain an erection. We talked about it. Jay was very concerned, and said, ‘Every time we start I know I won’t keep an erection, or I won’t get one.’ I kept reassuring him. I didn’t want him to worry.”

Jay was frustrated, and tried to use up his sexual energy on more physical activities. He took up athletics with a vengeance, He felt better after a good sweat, but the erection problem persisted. Yet, unlike some couples, Jay and Hilda did not stop communicating. All through this difficult period, they remained emotionally close. The skills that had enabled them to weather financial and health problems kept them going through this very difficult time. Bolstered by the fact that they had such a strong relationship, Hilda didn’t feel personally threatened by her husband’s problem. And she made sure she was completely involved in seeking a solution. “I went with him to the doctor all the time! In fact, I insisted on being there. One doctor kept trying to get me to leave, but I told him, you’re not going to show me anything I haven’t seen before!”

Finally, after a confusing and frustrating period of time, a specialist diagnosed Jay’s problem: Peyronie’s disease. Although some patients get better with nonsurgical treatment, the physician thought Jay’s condition was unlikely to reverse itself. If Jay wanted to have erections, his treatment would have to be a penile implant.

As with every other aspect of the problem, the couple discussed the proposed solution in some detail. Jay decided to have the operation, and Hilda agreed and supported his choice.

If s now been almost 18 months since Jay had the surgery, and he and his wife are quite happy with the results. “We had coped with so much that this wasn’t all that much to deal with. We work together,” says Hilda.

In this case, Jay and Hilda functioned as a team throughout Jay’s potency problem the same way they had dealt with other stresses. And although Jay’s physicians apparently didn’t take full advantage of the fact that Hilda was an available source of important information about her husband’s spirits, concerns and general well-being, she and her husband made sure that she remained involved.

Jay and Hilda had a lot going for them including many years of practice in talking openly to each other and a history of good sexual relations. But even couples who get off on the wrong foot can reroute themselves before it’s too late.

*89\184\8*

THE MEANING OF SEX IN YOUR RELATIONSHIP

admin — Fri, 27 Mar 2009 06:11:58 +0000

It is important to have a realistic understanding of the nature of your relationship with your sexual partner. A restored erection is no guarantee of improvement in a relationship that may be suffering emotionally, nor is erectile function the key to romance or monogamy. Rick’s response to having ED, living with it, and finding a treatment for it provides one real-life example. At thirty-nine, he was a successful commercial photographer. Divorced, he liked a life where models posed for

him during the day and succumbed to his considerable charms at night. Having a monogamous relationship was the last thing on his mind when ED brought him to my office.

“You know what it is?” he asked me, grinning slyly. “Too many women, that’s what. They’ve just worn me out.”

“How long have they been ‘wearing’ you down?” I wanted to know.

Looking at me sheepishly, he answered truthfully. “It’s been six

months.”

“What happened back then?”

Thinking for a moment, Rick said, “I never considered it before, but it’s when I started having insomnia. It’s something I’ve had off and on for years, but recently it’s been awful. What’s really terrible is that I’m awake so much of the time—and I can’t use it to have sex.”

“So you were satisfied with your sex life the way it was?” I asked.

“Sure, what was not to like? I had a lot of women. I loved it—it was the way I dreamed of life being when I was a teenager.”

“Then sex was the most important part of your relationship with those women?”

“What relationship? We slept together; that’s what I wanted. It’s what they wanted, too.” Then he added, “Well, most of them. Sometimes they hinted that they wanted more; but by that time I was ready to move on anyway. But I didn’t think they had anything to complain about. After all, ‘satisfaction guaranteed’ was my motto.”

After telling Rick about the oral medications available to him he was, to say the least, ecstatic. “I can be a man again,” he said. “I don’t have to feel lousy anymore.”

Rick’s story makes it clear that, for him, sex is basically a mutually satisfying recreational activity. Consider his comments:

• he was satisfied with his sex life prior to the onset of ED and happy with his frequent partnerings

• sex was the core of his limited relationships

• he had no relationship aspirations, nor did he wish for a long-term relationship with anyone

• the thought of a renewed, invigorated sex life was all that he yearned for

• he had no inclination to change his emotional lifestyle

• he intended to continue his pre-ED sex life because it worked for him

What the medication could do was restore Rick to his pre-ED life, which was precisely what he wanted. Having been married and divorced, for the time being Rick was perfectly content with the level of intimacy he achieved during his sexual encounters. In his case, limited safe sex was the extent of the relationship he sought with a partner. Once restored, he felt that his life was again complete. “Life couldn’t be better,” he said. “Between the great ladies I get to meet and share some good loving with, and the wonderful family and friends that I have, what more could I want?”

*61\183\8*