News for the ‘Men’s Health-Erectile Dysfunction’ Category
AFTER THE POSTNATAL EXAMINATION – CONCLUSION
Many of us have difficulty in accepting our own parents as sexually active people and some women may have difficulty accepting their own sexuality now that they too are mothers. There is another group of women for whom the experience of having their own baby brings an ‘echo of the past’ (Tobert, 1987).That is, they are reminded of themselves as babies or of other babies in their life. The episode may be very varied and is specific for each individual woman. Sometimes the memory may be of past sexual abuse and disclosure to a sensitive person around the time of the birth of their own baby is not uncommon. Sometimes the memory is of the death or illness of a sibling.
*181/197/1*
Edited: April 7th, 2009
THE STEREOTYPES – ‘MEN NEED TO BE IN CONTROL’ (INTRAUTERINE CONTRACEPTIVE DEVICES (IUCDS))
An IUCD invests much control in the doctor. Maybe it has been discussed, perhaps even with both parties. All the same, it is a foreign body. It is hard, metallic, and considered an abortifacient by some people, as well as being seen as a possible source of disease. Men can frequently feel threads and worry about dislodging it. One man said, T knew when she had a coil in because I could taste the metal when I kissed her.’ There is often disbelief that something so tiny can work. When a small sample of men were asked to rank contraceptive methods in order of efficiency, all men put IUCDs bottom of the list.
Some of the anxiety about the method may reflect the general awareness of the safety of modern contraceptive pills and the threat of pelvic infection, even although that is a small risk in multipara who are in a stable relationship. Many people are well informed and may wish to discuss the risks of specific infections such as chlamydia. Despite reassurance one can hear a certain ‘I told you so’ attitude from men towards the coil if complications arise. This can be interpreted as being an expression of healthy caution about a contraceptive method that asks for such a degree of trust in the doctor from the woman and her partner.
*144/197/1*
Edited: April 7th, 2009
THE WANTED BABY – DO I WANT A BABY?
Marie Stopes wrote her book for lovers in the early days of contraception when ignorance of sexual matters abounded. Pregnancy was an inevitable consequence of married love, and contraception was used to space babies sensibly to allow the mothers to recuperate from childbirth. Today women can choose, with varied forms of contraception, either to have no babies at all, to have and space them, or to defer them until the most favourable time. Among these many patterns are women who fluctuate between wanting and not wanting babies.
Mrs N. married on the understanding that neither of them wanted a baby. She was referred by a gynaecologist to a specialist in psychosexual medicine because she was still complaining of dyspareunia following a laparoscopy and urethral dilatation, performed in an attempt to find the cause for her pain. Nothing abnormal had been found. She had been complaining of dyspareunia for 18 months and there had been no intercourse for a year.
She was a smart business woman wearing a suit, who came briskly into the room and sat down. She very quickly began to tell the doctor how angry she was with the people in the hospial. She had felt weak after the operation, so much so that she had to be off work for a whole week. No one had warned her that it would be like this, with so much abdominal pain and feeling so unwell and her original problem had certainly not been resolved.
*107/197/1*
Edited: April 7th, 2009
PSYCHOSEXUAL PROBLEMS IN YOUNG PEOPLE (CONCLUSION)
This cautionary tale illustrates how a patient’s thick folder arises. Such a story should alert the doctor to the probability of a psychosexual problem which has not been resolved. It is interesting that at no time was there any exploration of the girl’s own sexual feelings, perhaps because no proper psychosexual vaginal examination had been made, despite various attempts at swab and smear taking, when she was always very tense. Another lesson to be learnt is if there is dissatisfaction with the contraceptive method it is worth referring back to the notes of the very first consultation, for the clues are often there.
*71/197/1*
Edited: April 7th, 2009
DECISION TO USE CONTRACEPTION (GENERAL INFORMATION)
The decision to use contraception or to have a baby always involves ambivalent feelings, which are often based on unconscious factors. It is essential for the doctor to get ‘enmeshed’ with the patient during the consultation. Understanding of what is happening inside the patient can then be obtained and shared. She can then take more conscious control and make more sensible decisions for herself. Whatever the age of the woman or the couple, and in whatever setting the contraceptive advice is being given, these matters will have to be considered if the patient is to receive adequate care.
*33/197/1*
Edited: April 7th, 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