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PROSTATITIS CLASSIFICATION: CHRONIC NONBACTERIAL PROSTATITIS

admin — Fri, 11 Feb 2011 11:19:25 +0000

More than 90% of cases of prostatitis are chronic nonbacterial cases. Unfortunately, the cause and appropriate treatment remain elusive. In some cases, occult infection may be the cause. When nucleic acid testing is performed on prostate biopsy specimens, evidence of infection is found in up to 77% cases. These studies were not well controlled, and response to antibiotic treatment was found to be poor. Other possible causes include atypical infections (Chlamydia, Trichomonas, Mycoplasma, Ureaplasma), reflux secondary to urethral spasm, excessive ejaculation, infrequent ejaculation, prostate trauma (as with receptive anal intercourse), interstitial cystitis, allergy, and stress.
Symptoms and signs in patients with chronic nonbacterial prostatitis are the same as those for bacterial causes. Urine and prostatic fluid cultures are negative in nonbacterial cases. The NIH chronic prostatitis symptom scale can also be applied to nonbacterial cases.
Treatment of chronic nonbacterial prostatitis is generally disappointing, since the response rate is so poor. Many clinicians believe that a 1 -month trial of antibiotics to cover for occult infection is reasonable. Other treatments include sitz-baths, anti-inflammatory agents, Quercetin (a bioflavinoid), stress reduction, alpha-blockers, allopurinol, avoiding caffeine, and transurethral microwave thermatherapy. The number and variety of treatments reflect the confusion surrounding this illness. More research is needed to improve the quality of life in men suffering from this disease.
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HUMAN SEXUAL RESPONSE

admin — Tue, 18 Jan 2011 11:23:33 +0000

Sexual response is a physiological process that involves different stages. The biological goal of the response process is the reproduction of the species. Human psychological traits greatly influence sexual response and sexual desire. Thus, we may find relationships with one partner vastly different from those we might experience with other partners.
Sexual response generally follows a pattern. Laboratory research has delineated four stages within the response cycle, and researchers agree that each individual has a personal response pattern that may or may not conform to the stages observed in experimental research. Both males and females’ sexual responses are somewhat arbitrarily divided into four stages: excitement/arousal, plateau, orgasm, and resolution. Identification of these stages was primarily achieved by researchers William Masters and Virginia Johnson in laboratory situations in which genital responses were carefully measured, using specially designed instruments. Regardless of the type of sexual activity (stimulation by a partner or self-stimulation), the response stages are the same.
During the first stage, excitement/arousal, male and female genital responses are caused by vasocongestion, or increased blood flow in the genital region. Increased blood flow to these organs causes them to swell. The vagina begins to lubricate in preparation for penile penetration, and the penis becomes partially erect. Both sexes may exhibit a “sex flush,” or light blush all over their bodies. Excitement/arousal can be generated by touching other parts of the body, by kissing, through fantasy, by viewing films or videos, or by reading erotic literature.
The plateau phase is characterized by an intensification of the initial responses. Voluntary and involuntary muscle tensions increase. The female’s nipples and the male’s penis become erect. A few drops of fluid, which may contain sperm, are secreted from the penis at this time. This fluid is termed pre-ejaculatory fluid.
During the orgasmic phase, vasocongestion and muscle tensions reach their peak, and rhythmic contractions occur through the genital regions. In females, these contractions are centered in the uterus, the outer vagina, and the anal sphincter. In males, the contractions occur in two stages. First, contractions within the prostate gland begin propelling semen through the urethra. In the second stage, the muscles of the pelvic floor, the urethra, and the anal sphincter contract. Semen usually, but not always, is ejaculated from the penis. In both sexes, spasms in other major muscle groups also occur, particularly in the buttocks and abdomen. Feet and hands may also contract, and facial features often contort.
Muscle tension and congested blood subside in the resolution phase, as the genital organs return to their prearousal states. Both sexes usually experience deep feelings of well-being and profound relaxation. In some males, a refractory period occurs. Males experience a period of time in which their systems are incapable of subsequent arousal. This refractory period may last from a few minutes to several hours. The length of the refractory period increases with age.
Following orgasm and resolution, many females are capable of being aroused and brought to orgasm again. Males and females experience the same stages in the sexual response cycle; however, the length of time spent in any one stage is variable. Thus, one partner may be in the plateau phase while the other is in the excitement or orgasmic phase. Such variations in response rates are entirely normal. Some couples believe that simultaneous orgasm is desirable for sexual satisfaction. Although simultaneous orgasm is pleasant, so are orgasms achieved at different times.
Sexual pleasure and satisfaction are possible without orgasm or intercourse. Achieving sexual maturity includes learning that sex is not a contest with a real or imaginary opponent. The sexually mature person enjoys sexual activity whether or not orgasm occurs. Expressing love and sexual feelings for another person involves many pleasurable activities, of which intercourse and orgasm may only be a part.
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SEXUALITY: NORMALCY AND SEXUAL BEHAVIOR

admin — Fri, 17 Dec 2010 11:10:05 +0000

Most of us want to fit in and be identified as normal, but how do we know which sexual behaviors or practices are considered normal? What or whose criteria should we use? These are not easy questions.
Every society sets standards and attempts to regulate sexual behavior. Boundaries arise that distinguish good from bad or acceptable from unacceptable and result in criteria used to establish what is viewed as normal or abnormal. Common sociocultural standards for sexual arousal and behavior in Western culture today include the following:
- The heterosexual standard. Sexual attraction should be limited to members of the other sex.
- The coital standard. Penile/vaginal intercourse (coitus) is viewed as the ultimate sex act.
- The orgasmic standard. All sexual interaction should lead to orgasm.
- The two-person standard. Sex is an activity to be experienced by two.
- The romantic standard. Sex should be related to love.
- The safer sex standard. If we choose to be sexually active, we should act to prevent unintended pregnancy or disease transmission.
These are not laws or rules, but rather social scripts that have been adopted over time. Sexual standards often shift over time, and many people will choose not to follow them. We are a pluralistic nation, and that pluralism extends to our sexual practices. Rather than making blanket judgments about what is normal or abnormal, Kelly suggests we view sexual attraction and sexual actions in relative terms by asking the following questions:
- Is a behavior healthy and fulfilling for a particular person? Is it safe?
- Does it lead to the exploitation of others?
- Does it take place between responsible, consenting adults?
In this way, behavior can be viewed along a continuum that takes into account many individual factors. Use these questions to help explore your feelings about what is normal for you.
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DRUGS TO LOWER CHOLESTEROL: MORE QUESTIONS ABOUT STATIN DRUGS

admin — Thu, 23 Apr 2009 07:47:28 +0000

Are statins beneficial for older people?

For a start it is controversial whether high cholesterol is a problem in people over 70 years of age. A study called “Cholesterol and mortality: 30 years of follow-up from the Framingham study” was published in the Journal of the American Medical Association in 1987. Cholesterol levels were measured in 1959 men and 2415 women aged between 31 and 65 years of age, who were free of cardiovascular disease and cancer. You may be shocked to know that the study showed there was no increased death rate in people with high cholesterol over the age of 50. So if you make it to 50 years of age, you are not more likely to die of a heart attack if you have high cholesterol than people who have normal or low cholesterol, according to this study. In the study there was a direct association between low levels of cholesterol and increased death.

Researchers at the San Diego School of Medicine found that high cholesterol in people over 75 years of age is protective, instead of harmful. They also stated that low cholesterol is a risk factor for heart arrhythmias, or heart rhythm irregularities. A study in the European Heart Journal recruited 595 people with coronary heart disease who had a total cholesterol level of 4.1mmol/L or less; they were compared with a group of 10 968 people with heart disease who had a cholesterol level above 4.1mmol/L. The study found that the risk of cardiac death was the same in both groups. Therefore, there was no protective benefit to having a low cholesterol level. The study found that “the most frequent cause of non-cardiac death associated with low total cholesterol was cancer”. What is the point of worrying about getting your cholesterol down when it won’t help you to live any longer? Elderly patients are more susceptible to side effects caused by statin drugs. One reason for this is that older people are more likely to take several medications, making drug interactions more likely to happen. Statin induced muscle soreness (myopathy) is more common as we get older, the more other medications we take, the more other diseases we have, and during postoperative periods. All of these factors are more prevalent in the elderly. Muscle pain makes people less likely to exercise; therefore they miss out on the cardiovascular benefits it provides.

Statins without a prescription

In 2004 a low dose version of the cholesterol lowering drug Zocor became available without a prescription in the UK. The theory behind this move was to make statins more widely available to the public, in order to prevent heart disease in at risk individuals. Dr John Reckless, chairman of Heart UK believes statins are safer than aspirin, and “rather more people do need statins than are currently getting them”.

Statins can of course have serious side effects, and this move will place an unnecessarily high number of people at risk. They should never be used by pregnant women because they can cause limb defects. Professor Tom Sanders is a nutritionist at King’s College, London, and nutrition director for Heart UK. According to Professor Sanders, “At the age of 40, your risk of having a heart attack is below one in 1, 000, so any reduction is really quite miniscule in terms of benefit”. Unfortunately, being able to buy Zocor over the counter reinforces the idea that we can eat what we like and never exercise, and a pill will undo the damage.

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THE STEREOTYPES – ‘MEN NEED TO BE IN CONTROL’ (VASECTOMY – INTRODUCTION)

admin — Tue, 07 Apr 2009 07:23:36 +0000

Loss of fertility might be considered the moment when the man becomes unarmed. ‘Have a vasectomy and join the club.’ It is impossible not to have attitudes to vasectomy, though the overwhelming first response to the event was that it was ‘a small job and made no difference’.

There is evidence that the quality of marriage for the woman may improve after vasectomy (Adler, Cook, Gray et al., 1981). On the other hand, there is a measurable regret for some men which leads to requests for reversal (Howard, 1982).

Mr G. is a fireman and one of those men who described his vasectomy as a ‘small job’. He then reassured himself by saying it was a difficult part of life at last put behind them and that they could relax. Sex was the same and the family complete. The doctor felt a strong hint that discussion of the matter should now be completed, and it was for the time being. Later Mr G. relaxed and was able to say how much more time he had at home, particularly because ‘we don’t seem to need so much sex now, and anyway the children need so much of our time’. Some time later the discussion returned to contraception. ‘Did it take long to decide about a vasectomy?’ ‘No. She said . . . . , well, we agreed that I would do my bit, and it didn’t matter who was done.’ There was a long silence. ‘I wonder if your wife would have decided so quickly about being sterilized herself?’ After a pause he replied, ‘You know, in a way, I thought more about it afterwards. It took me several months to get used to it. At first I thought I was bound to go off sex, but it is no good getting cross about it.’ Mr G. became visibly upset, and it was necessary to arrange a follow-up consultation later, which had a satisfactory outcome.

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INFERTILITY AND THE CONTRACEPTIVE CONSULTATION – INSTANCE 2

admin — Tue, 07 Apr 2009 07:17:19 +0000

She said, ‘We waited all these years deliberately until the time was right.’ Their world was now ready for a baby; they both had good jobs, their new house was completely furnished, and most of their friends were now having babies. It was just this physical block and the shape of her vagina that was causing the difficulty.

They had tried on so many occasions but her husband’s penis just would not go in.

The doctor was able to do a smear quite easily, probably because there had been some introital stretching with their attempts at intercourse, and she tried to reassure her that there did not appear to be a physical block in her vagina. However, she felt that more time was needed to explore this woman’s difficulties, and she referred her to a special psychosexual clinic.

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THE DOCTOR AND THE UNPLANNED PREGNANCY – RESPONSIBILITY

admin — Tue, 07 Apr 2009 07:10:50 +0000

The responsibility of dealing with abortion rests uncomfortably on the shoulders of the medical profession. Doctors are trained to preserve life and many feel a moral and ethical objection to terminating it. However, views are often confused and despite vociferous objections to liberal abortion from many in the medical and nursing profession, they themselves have been shown to make good use of the abortion services (Potts, Diggory and Peel, 1977). A further difficulty is that the patient has usually made her own diagnosis and has prescribed her own treatment. Medical training, on the whole, teaches doctors to take a careful history, evaluate the symptoms, make a diagnosis and offer treatment and advice. This may lead to some doctors finding it difficult to be mere technicians, responding to the patient’s wishes. Overall, therefore, in dealing with a woman with an unplanned pregnancy, we may end up with a reluctant doctor and a reluctant patient.

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CONTRACEPTIVES – PILL

admin — Tue, 07 Apr 2009 07:02:06 +0000

The Pill is a very powerful contraceptive; taken correctly the chances of pregnancy are small. This is a great benefit to women, but it is also a double-edged sword. The desire to become pregnant is not always an entirely intellectual and rational emotion, and many women enjoy the element of risk inherent in other, less safe methods. The very effectiveness of the Pill can trap her, she feels taken over, becomes angry at this, and this anger is easily transferred to sex itself, causing frigidity. Sometimes, there is a cogent and usually unconscious feeling that this total control is cheating nature, that nature will get its own back in some unspecified way, and no amount of scientific explanation of the overall benefits of oral contraception will alter this. Whatever the reasons for unease at taking the Pill, the result is often that the women forgets to do so, or develops a series of problems necessitating frequent changes of Pill. She is signalling that the method, although extremely effective as a form of contraceptive, is wrong for her. Exploration of the hidden reasons for these anxieties help her to decide on the method which is best.

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HISTORICAL AND POLITICAL ATTITUDES TO FERTILITY – FAMILY PLANNING

admin — Tue, 07 Apr 2009 06:55:38 +0000

However, deeply held cultural and religious traditions are often more powerful than political pressures, and they continue to influence individuals in much of the developing world and in certain ethnic groups from Asia and Africa in Britain. For example, there is a West Indian belief that a woman has a certain number of children inside her which she has to have and that nature should not be interfered with. We seek our immortality through our descendants, our children and our grandchildren. To thwart the possibility of conception can produce, at a deep psychic level, guilt about being anti-life and opposed to God. The words ‘contraception’ and ‘birth control’ sound hard and alienating, going against nature. Family planning, though less applicable to young people seeking advice on preventing pregnancy, has a softer ring to it. Although nowadays most people, certainly in the western world, do not want many children, and the benefits of contraception are self-evident, nevertheless there is a hidden psychic cost that is often denied but that can surface from time to time.

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SEX THERAPY: HOW TO HELP YOUR LOVER

admin — Fri, 27 Mar 2009 07:49:47 +0000

Here are some pointers on how you can help your situation:

• Be warm, friendly and physical towards your lover. Let him know you want to hug, kiss and cuddle him—but that you don’t expect intercourse now.

• Tell him that you want him to hold you, that you need him. Communicate directly, but gently. You might say, for example, “I want to be close to you. Please touch me. I don’t need you to use your penis, I just want us to lie here together and be close.”

• Do not tell your lover that intercourse doesn’t matter. If he believes you, he may question just how much you liked intercourse before. And if he doesn’t believe you, he’ll say to himself, “She thinks I’m so fragile that she can’t tell me the truth anymore,”

• Sometimes a couple unconsciously gets into arguments so they’ll be angry and won’t want to have sex. Try to avoid this self-defeating trap, and if you think your partner is falling into it, point it out.

• Don’t assign blame for the problem. Don’t say, “Ifs your problem, you fix it.” Remember, the problem affects both of you. And the solution needs to come from both of you, too.

Oversympathetic Response

Women whose husbands suffer potency problems may develop sexual problems themselves. Of 151 such women, more than 60 percent reported sexual problems in a study done at Loyola University’s Sex Clinic. Only 8 percent of these women reported that their sexual problem developed before their husband’s. The author, Domeena C. Renshaw, M.D., notes that most of the men had an erection problem for anywhere from two years to as much as a decade before they went for help. Early treatment of an erection difficulty may prevent many women from developing sexual problems of their own.

Most of the women did not blame their husbands for the sexual problems. They were, says Dr. Renshaw, “supportive, sensitive and concerned.”

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