News for March 2009
NEW BPH TREATMENTS, AND HOW TO EVALUATE THEM : RESULTS AND COMPLICATIONS
Results. Long-term results with permanent stents are not available. Temporary stents made of nickel alloy appear to be well tolerated, with few problems of becoming encrusted with stones. The permanent stents made of nickel-titanium alloy have been used for both the treatment of BPH and of urethral strictures. These also appear to be associated with fewer problems such as encrustation and urinary tract infection.
Complications with the stents are few and, in most cases, seem to resolve themselves over time. Most men experience irritative symptoms—some incontinence, a sense of urgency to urinate, and a need to urinate frequently— and some discomfort in the perineum for days to weeks after the operation. Anticholinergic drugs may be prescribed to help slow a too-frequent need to urinate. A few men in one study reported painful ejaculation the first time they had sex after the operation, but this went away with later sexual activity.
Sometimes the stents don’t work out—if the irritative symptoms persist, or if the epithelial cells fail to cover the tubes adequately, causing them to become clogged. In these and other studies, when this happened the stents were removed intact, without harming the urethra or the bladder’s external urinary sphincter. Stents can also be repositioned, and sometimes just a slight adjustment in their placement can resolve such symptoms as incontinence and urinary retention.
*280\201\8*
Edited: March 30th, 2009
WHEN DO I NEED BPH TREATMENT?
Many men would much rather suffer the inconvenience of BPH than seek medical or surgical help. However, there are times when symptoms can no longer be ignored and treatment is needed. These include:
A “Backed-Up” Bladder, Impaired Kidney Function, or Overflow Incontinence. Sometimes, when the bladder is too full for an extended period and is not emptying completely, the mounting pressure can cause the urine to back up in the kidneys—which can lead to severe damage if left untreated. The first step here is simply to drain the bladder, by means of a catheter threaded into the urethra through the penis. For most men, function of the upper urinary tract (kidneys and ureters) improves right away. Some men may be given oral replacement of fluids and key minerals to flush the body of impurities and prevent dehydration once the pressure is relieved. The fate of the lower urinary tract (recovery of function in the bladder, prostate, and urethra) is less certain, and depends on how much—and for how long—strain has been placed on the bladder.
*241\201\8*
Edited: March 30th, 2009
PROSTATE CANCER/PATHOLOGIC FRACTURE: WEIGHT LOSS
What’s wrong with losing weight—particularly if you’ve spent the better part of your life trying to do just that? The problem here is that people who have cancer need to eat. Losing weight means losing strength and the body’s reserve for fighting off illness.
No appetite? Able to eat just a little at a time? The thought of vitamins makes you gag? Then do what pregnant women with bad morning sickness do: Eat less, more often. Have small, nutritious snacks throughout the day. Make every calorie count. Empty calories in sugared iced tea or soda won’t do your body as much good as the calories in juice, for instance; the same goes for the empty calories in a doughnut versus the calories in a muffin or slice of banana bread. Finally, if you just can’t force yourself to eat as much food as your body needs, you may want to try a calorie-packed liquid nutrition supplement like Ensure or Sustacal. Most hospitals have nutritionists available to help you solve dietary problems like these. That’s what these people are there for—use them!
In severe cases of weight loss, doctors can insert a gastrostomy tube, which bypasses the upper digestive tract and allows patients to get much-needed nutrition in liquid form. This tube “really takes the burden from the patient’s shoulders,” says one Johns Hopkins gastroenterologist. This tube provides a painless route for food to get to your stomach. It’s comfortable and discreet— hidden by clothes—and it can be removed when your appetite comes back and you don’t need it anymore.
*202\201\8*
Edited: March 30th, 2009
PROSTATE CANCER: WHY HORMONES DON’T CURE
Why not? Because prostate cancer, scientists have learned, is “heterogeneous,” a cellular melting pot. It’s a bunch of different cells mixed up together—so a drug or hormone treatment that targets one kind of cell, for instance, won’t have any effect against another variety. The cancer is made up of many different kinds of cells, and some of them have learned to be resistant, to grow in the absence of androgens, or male hormones. These are called androgen-independent, or -insensitive cells.
For years, scientists have been working to understand why hormonal treatment eventually fails—why some cancer cells seem to kick in and grow with such vengeance. “There’s probably no area of cancer therapy where we’ve got as many good options as we do for treating the hormonally responsive element of prostate cancer,” says a Johns Hopkins cancer researcher. “In sharp contrast, we have almost nothing that has proved very useful in managing the hormonally independent portion of the cancer.”
When a man starts hormone therapy, the early results are successful and highly encouraging: The tumor shrinks, PSA levels drop in the blood, and the patient feels better. But in the prostate, only the hormone-dependent cancer cells have been affected. The rest, the cancer cells that have nothing to do with hormones, go on about their merry, proliferative business, oblivious to the hormonal war being fought just cells away.
Scientists believe that these androgen-independent cells probably inhabit the prostate for years; they don’t just suddenly appear one day after the cancer is diagnosed. And so to do battle with them, many scientists feel, in the future hormone therapy must be combined with something else—chemotherapy, drugs targeted specifically at these androgen-independent cells. Today, however, effective treatment along these lines is not yet possible in men, and is only under experimental study.
*164\201\8*
Edited: March 30th, 2009
RADICAL PROSTATECTOMY: THREE GOALS TO SURGERY
There are three goals to surgery: Removing all of the tumor, preserving urinary control, and preserving sexual function. Sexual function is number three because first, in order of importance, it is number three, and second, if it is lost, there are many ways to restore it to normal. Men who are impotent after radical prostatectomy have normal sensation, normal sex drive, and can achieve a normal orgasm. The one element they may be lacking is the ability to have an erection sufficient for intercourse, and this is a problem that can be fixed.
With the reduction in side effects, and with better screening techniques to identify men with localized prostate cancer, radical prostatectomies are now performed more often than ever before, lie-cause of this, there’s a wealth of information about long-term results, and the news is good: At ten wars after surgery, 70 percent of patients have undetectable levels of PSA; only 4 percent develop local recurrence of cancer, and only – percent have distant metastases. Overall 92 percent of men have complete urinary control, and only 2 percent of men have long-term, troublesome problems ‘wearing more than one pad a day). Total urinary incontinence is rare (and, as in impotence, there are several ways to improve this).
*127\201\8*
Edited: March 30th, 2009
ABORTION
Abortion is an emotive and therefore a controversial subject. By removing the embryo (which is the name given to the fertilised egg in the first eight weeks of a baby’s life) or the foetus (which is what it is called thereafter), a potential life is lost.
However, Nature also makes use of abortion. In some unknown way, a pregnant woman’s body ‘inspects’ an embryo and if it is defective it is likely to be rejected without the woman even necessarily knowing she has conceived. It is thought that a half to three-quarters of all fertilised eggs are lost like this. Later, when the pregnancy is recognisable and established, a further 10 to 15 per cent of pregnancies fail, mostly between the second and third months. Many such foetuses are found to be visibly defective. Sometimes, the woman may be hormonally deficient or may have an abnormality such as fibroids. All such naturally occurring abortions are labelled ’spontaneous’ and the public calls them miscarriages. Not all imperfect babies are spontaneously aborted. Around 2. per cent of babies are born with congenital defects, but most of these are slight. Nature may be a little more ’strict’ in her scrutiny of female embryos, in that they are probably rejected earlier than male ones. This may account for the preponderance of male births of around 104 male to 100 female.
Abortions which are caused by human intervention are called induced abortions. They can be self-induced, criminally induced, or therapeutically induced (by doctors). One effect of the passage in Britain of the Abortion Act of 1967, which legalised therapeutic abortion, has been to eliminate almost entirely the first two categories.
The Abortion Act allows abortion provided that it is carried out in places approved for that purpose and is undertaken by a medically qualified person, and that two medical practitioners certify that the pregnant woman’s existing children or her own physical or mental health would be at a greater risk if the pregnancy continued than if it were terminated. If there is a substantial risk that the child would be born handicapped then abortion is also legally allowed. By and large the medical profession increasingly supports the Act because it means that women no longer have to become unwilling mothers or be abandoned to the dangers of illegal abortion. Understandably some obstetricians and gynaecologists are somewhat reluctant about the Act because it is they who have to carry out the operations when their training and orientation is towards helping women to have live, healthy babies safely.
In an ideal world no woman would become pregnant unless she wanted a baby for its own sake and was able to provide an emotional and physical environment in which it could prosper. But there is evidence that up to a quarter or so of all babies born are not wanted in this positive way although, we should add, they may not be completely un wanted.
Women who have abortions are sometimes represented as being unnatural or frivolous, but there is another way of looking at the subject. The age group which has most abortions is the late adolescent and young adult one. There is no evidence to suggest that these women are trying to avoid pregnancy altogether, only this pregnancy. Presumably, a strong motive for seeking an abortion is that they cannot provide properly for a child at the particular time and so want to defer pregnancy until they can. From this point of view having an abortion is a responsible act.
The younger generation, contrary to appearance perhaps, is the one which encounters the most problems arising from psychosexual conflicts and confusions. Many long-married women with families have abortions because they cannot face another baby for a whole range of reasons. Whether or not such women should be ‘allowed’ to use abortion as a form of birth control is a debatable subject, which we do not want to go into here, but some women only come to the decision after much heart-searching and agonising. Almost all women are disturbed by the event.
As a result of various difficulties, the National Health Service in the UK is able to undertake abortions in only half of all cases. The remainder have to make private arrangements, usually at a private hospital specialising in the operation. Such specialist organisations are usually very efficient because of the experience they acquire in doing the operation. There are also both National Health Service and private counselling services which help women decide whether or not to have an abortion and then help them, practically. If an abortion is the decision, then good counselling can reduce anxiety, guilt, misapprehension and the possibility of depression later. An experienced counsellor may also be able to detect unconscious motivations, a knowledge of which may prevent the woman starting another unwanted pregnancy. Pregnancy bureaux or advisory services exist and carry out immediate pregnancy tests. They provide counselling, advice and help in connection with abortion and have to be licensed with the Department of Health to ensure their competence.
Over the years the techniques used to carry out abortions have become more refined and safer. In ordinary, uncomplicated, early cases, an abortion is safer than having a baby, even though having a baby is itself now a very safe process.
*130\164\2*
Edited: March 27th, 2009
SEXUAL PROBLEMS IN WOMEN
The extent of sexual problems in women as revealed by the survey we quoted earlier in the chapter suggests that all the clinics and therapists dealing with them are doing no more than scratching at the surface. When one bears in mind that women are biologically endowed with an enormously greater sexual capacity than are men, the extent of the present situation is impressive and a cause for concern. There are many ways of tackling the problem. The best course, in our view, is prevention, by bringing up children differently. Better sex education for girls is becoming an urgent necessity in an age when men are being increasingly encouraged to perform to their partner’s satisfaction and when women have increasing sexual expectations. The discrepancy between what women are capable of and what they can achieve may in itself account for the marked difference between the sexes in the prevalence of emotional illness.
Women would probably perform better if they were able to communicate more to their partners and if men were educated to understand them better.
To say that men suppress women is provably wrong. Their mothers probably suppressed them far more as girls — and much more than they did their brothers. Men often complain that their women undervalue themselves and so underachieve. In fact they tend to see more potential in their women than the women do themselves.
These influences and many others, exert negative influences on female sexuality generally. It could be that human females are designed to be sexually dissatisfied, at least to some degree, so that they have an incentive to have further sexual activity. Human females are, in effect, permanently ‘on heat’ or ‘in season’ because humans are capable of rearing their young in any season of the year in which they are born.
Most women seem to be in touch with a deep inner sexuality which they fear because of the consequences which could result if they were really to let go. In fact many sex problems in women are the result of what is called ‘reaction-formation’ against their own powerful sexuality. They have learned that it is bad to be sexual and then have realised how sexual they are. Thereafter their interests, attitudes, behaviour and pleasures all have to be presented, even to themselves, as the opposite, or a modification of what they really are.
Re-education can rapidly and dramatically alter this situation, especially if the woman’s partner is encouraging. Many women are afraid to be themselves for fear of earning condemnation and this is one reason why bold, self-confident and sexually dominant men, who expect a woman to be very sexual, appeal to so many women. Underconfident, shy and embarrassed partners simply make many women feel inhibited as well.
If men were better educated to know about and to accept female sexuality there would be fewer sex problems in women.
*110\164\2*
Edited: March 27th, 2009
FOREPLAY (PLEASURING): ANAL STIMULATION AND VIBRATORS
Many women enjoy having their anus stimulated, especially as they near orgasm. How you do this will be dictated by what your partner wants, but a finger (or tongue) encircling the anus can be very stimulating. Some women like to have a finger tip inserted into the anus itself and others like a lot of anal sensation with several well-lubricated fingers. Whatever you do, be sure not to put the same fingers into the vagina after having been in the anus, as this can cause an unpleasant infection. Anal stimulation such as this cannot cause AIDS — unless of course your partner has the disease or is HIV-positive when there is a real danger. Anal play in faithful, healthy couples is perfectly safe.
Vibrators-Something else enjoyed by some women is to have a vibrator or dildo used on their vulval area generally or inside their vagina as part of foreplay. Most women, once proficient at having self-induced clitoral orgasms, are not very keen on the orgasms produced by a vibrator but there are exceptions to every rule and some enjoy their partners using a vibrator on them whereas they would not particularly like to do so themselves.
*90\164\2*
Edited: March 27th, 2009
THE FEMALE SEX ORGANS: BREASTS
In other societies other parts of the body are considered to be a greater ‘turn-on’ but the breasts have eclipsed almost all of these in the West, and a woman’s most easily observed signs of sexual arousal take place in her breasts.
Whilst about one third of men have some kind of hang-up about their penis size, about
three-quarters of all women are, according to one survey, dissatisfied with their breasts. This has come about partly because of the advertising world’s emphasis on a rather particular type of breast. Whilst it is probably true that men tend to prefer (and probably have been conditioned to prefer) large-breasted women, the variety of taste is wide and, anyway, no thinking man judges a woman solely by her breast size. There is no evidence that big-breasted women enjoy sex or breast-play any more than do their smaller-breasted sisters.
Interestingly enough, it seems that society’s ideal breast image is slowly changing anyway. The ideal woman as currently portrayed by the media is neither very slim nor very curvy. Her breasts are neither particularly big nor particularly small.
Breast pain is very common indeed among women of all ages. One UK study found that about two thirds of women had had it at some time in their lives and that about one third had their daily and sexual lives disturbed by it.
More than half of sufferers don’t seek medical help because they think that they’ll be treated as neurotic women but the condition is real enough and causes a lot of unnecessary suffering.
There are three types of breast pain. The first occurs cyclically, gets better with the menopause and does quite well with hormone treatment. The second is non-cyclical, tends to go on after the menopause and can be difficult to treat. And the third is really a type of cartilage problem in the chest underlying the breast and simply mimics breast pain.
Many women who have breast pain worry that it might be a cancer but it very rarely is and the vast majority can be reassured fairly easily on this point.
Stopping the Pill can help some women, as can stopping smoking and cutting right down on the amount of fatty foods they consume. Evening primrose oil is a proven cure in about half of all cyclical cases and a combination of this plus changes in life style listed above can greatly enhance this success rate.
*70\164\2*
Edited: March 27th, 2009
TYPES OF MARRIAGE LIFE-STYLE: THE PATRIARCHAL MARRIAGE
When two people live together for a long period, married or not and even if they are of the same sex, they need to work out some kind of structure which will enable them to function as a unit. Many marriage ‘experts’ have classified such relationships within marriage in great detail but because of shortage of space we will look here only at the four commonest types.
The patriarchal marriage-This is the most common marriage structure today, even with the tremendous growth of women’s power and influence. In this the woman looks to the man to be the stronger, the breadwinner, the leader (most of the time), the major decision-maker, and so on.
Surveys show that most women want (or have been conditioned into wanting) this type of marriage. Many women go about their lives very much as it suits them for most of the time whilst avoiding direct challenges to their husbands so that they feel patriarchal enough of the time to be happy. Undoubtedly many marriages thrive on this form of behaviour in the woman.
*50\164\2*
Edited: March 27th, 2009