Archives for Men’s Health-Erectile Dysfunction category
Many people with HIV infection have decided to combine the traditional therapies provided by Western medicine (described in detail later in this section) with alternative therapies, such as herbal therapy, acupuncture, dietary changes, and vitamins. Asking your primary health care provider which of these options have been proven useful, and which alternative therapies may be harmful, is a good idea. On the other hand, though your provider may be well versed in Western medicine, he or she may not have any knowledge (or only limited knowledge) of these other options. Many people with HIV infection therefore seek the advice of alternative practitioners to complement the care provided by their primary providers. Many books offer descriptions of the alternative therapies offered for people with HIV infection or AIDS.
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The other two-thirds of those who are carriers have what is called chronic persistent hepatitis; they exhibit less severe symptoms and in fact are frequently symptom free, with only mild inflammation of the liver. They are less likely to progress to the more worrisome complications of cirrhosis and liver cancer, although this is still possible.
They are also less likely to be infectious to others, although this too remains a possibility.
Even carriers can occasionally clear the virus from their systems and cure themselves of hepatitis B.
How and why some people clear the infection while others do not is not clear. For those who remain carriers, routine monitoring by a health care provider for complications from the disease is essential.
People with chronic hepatitis B infection may sustain damage to organs other than the liver, similar to that seen with hepatitis C infection (discussed subsequently). Such symptoms include disorders of the skin (polyarteritis nodosa), kidneys [glomerulonephritis), and blood cells (cryoglobulinemias).
People who become infected with hepatitis B are contagious to others during the weeks before they become symptomatic and for up to several months following infection. Those who become chronically infected are potentially infectious to others throughout their lifetimes. Those with chronic active hepatitis are more infectious to others than those who are only carriers (who have chronic persistent hepatitis). People with acute hepatitis B infection should be considered infectious to others until their blood work shows they have cleared the infection, which may take up to three to six months after infection.
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HOW COMMON IS IT?
In the United States, Chancroid is not a common STD. It is more common in the tropical and subtropical developing world, such as Africa, where it is the most common cause of genital ulcer disease (in the United States the most common cause of genital ulcer disease is herpes). The late 1980s saw an increase in the incidence of Chancroid in the United States, with about 5000 people diagnosed a year. Since then there has been a slight decline in the number infected each year.
Given the low incidence of chancroid in this country, who is at risk for contracting the infection? It’s important to know, first of all, that people who continue to have sex when they have Chancroid sores—most often sex workers and those who visit them, especially in urban areas in the East and South—easily spread the disease. Having sex with someone who has sores increases your chances of contracting this infection. In addition, individuals who use crack cocaine or abuse other mind-altering substances, including alcohol, are less likely to use good judgment and more likely to have unprotected sex with high-risk partners. Men are more commonly infected than women; not being circumcised increases the risk of acquiring this infection. Finally, anyone living in the United States who travels to other areas of the world where infection is common and engage in unprotected genital or anal sex with high-risk persons is at risk.
The incidence of chancroid in this country may be higher than statistics indicate. The diagnosis may be missed because the symptoms are very similar to those caused by herpes and syphilis (which are more common STDs in the United States), and because the bacterium that causes Chancroid is hard to culture.
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Clinical Stage versus Pathologic Stage
This can be pretty confusing. Clinical stage is an estimate, what a doctor believes a man’s prostate cancer to be, based on factors such as the digital rectal exam, PSA, transrectal ultrasound and needle biopsy. Pathologic stage is much more certain—and, for predicting the likelihood for cure, it’s essential— because a pathologist has been able to examine actual prostate tissue and, often, tissue from the lymph nodes, not just make guesses about it based on a few cells and test results. Until recently, knowing pathologic stage was only possible when the prostate was removed. Now, however, based on table 3.3, doctors have a much better way of estimating a man’s pathologic stage of cancer before surgery.
More on the Digital Rectal Exam and Staging
Like transrectal ultrasound, the digital rectal exam is not able to pick up microscopic cancer spread to the prostate wall and beyond. Because of this, the digital rectal exam tends to underestimate the stage of cancer. Studies have found that a significant number of cancers initially staged as T2b (Bi) end up being classified as higher because of cancer that has invaded the capsule of the prostate or the seminal vesicles. For cancer with an initial clinical evaluation of T2c (B2), this degree of “understaging” ranges from 39 percent to 66 percent. One reason for this is that the digital rectal exam is subjective; it depends on the experience and perceptiveness of the doctor performing it. Another is that the digital rectal exam can only give information about the prostate gland itself— and not even all of it, at that. And it certainly can’t tell anything about the nearby pelvic lymph nodes or bones. Also, if a man has had other treatment of a prostate disorder—a TUR, for instance, for BPH—this can cause the prostate to feel different on an exam, and it can throw off the digital rectal exam.
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The prostate is affected from up close—by the testes—and from long-distance—by the brain. Let’s begin at the top: The hypothalamus, located in the brain, makes a chemical messenger called LHRH, which is dispatched in signal pulses—like Morse code or flashes of light—to the nearby pituitary gland. These pulses tell the pituitary to transmit yet another chemical signal, called LH, which motivates the testes to make the male hormone testosterone.
Among other things, testosterone is responsible for secondary sex characteristics like post-puberty body hair and deepening of the voice, and for fertility. It is a major hormone that regulates the prostate. The adrenals also make some weak androgens; however, it’s questionable whether these adrenal androgens have a significant influence on the adult prostate.
Testosterone is important to the prostate, but not in its original form; it must be transformed to an active form. It turns out that testosterone is converted by an enzyme called 5-alpha-reductase to DHT. And DHT is the major androgen, or male hormone, inside the prostate cell.
Here’s how it works: Testosterone circulates in the blood. It enters cells in the prostate by diffusion, like water through a tea bag, and soon is transformed into DHT. DHT hooks up chemically with a specific protein, moves to the cellular seat of power—the nucleus—and quickly becomes a powerful force in the transmission of genetic information (DNA) from prostate cells.
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Breast-feeding prevents ovulation and causes temporary infertility. The stimulation of the nipples encourages the production of prolactin, a hormone necessary for the production of breast milk. It also inhibits the secretion of gonadotropin, a hormone necessary for ovulation. Without the release of an egg, pregnancy cannot take place. If you choose breast-feeding, you will breast-feed your baby on demand.
Breast-feeding as birth control is called the lactational amenorrhea method (LAM). LAM can be effective for up to six months after delivery only if a woman:
• has not had a period since she delivered her baby
• suckles her baby at least six times a day on both breasts
• suckles her baby “on demand” at least every four hours during the day
• provides nighttime breast-feeding at least every six hours—does not let her baby sleep through the night
• does not substitute other foods for a breast-milk meal
• does not rely on the method after six months Supplemental feedings become essential for the good health of the baby after six months. The reduction in breast-feeding stimulates the return of ovulation.
Effectiveness of LAM
Out of 100 women who use LAM, two to six will become pregnant with perfect use in the first six months. Up to 40 will become pregnant with typical use in the first six months.
Some women who rely on LAM incorrectly believe that they will not ovulate until after their first period. It is important to remember that ovulation occurs before menstruation. If a woman relying on LAM has a period, even a very light one, she should consult her health care provider immediately and use another method of birth control.
LAM does not offer protection against sexually transmitted infections.
Advantages of LAM
Breast-feeding has many health advantages for the baby.
• Breast-feeding provides the best nutrition.
• Breast-feeding passes on some of the mother’s antibodies to protect the baby from certain bacteria and viruses.
• Breast-feeding decreases the likelihood of infection from germs in water, other milk, or formula.
• Breast-feeding increases body contact and enhances comfort for the child and bonding between mother and child.
There are also advantages for mothers.
• LAM is effective in the first six months after delivery.
• LAM is inexpensive.
• LAM works immediately.
• LAM reduces bleeding after delivery.
• LAM requires no supplies or medical supervision. Women may initially benefit from consulting with a lactation expert, and they should be assisted as soon as possible if problems arise so that lactation is not disrupted.
• LAM does not affect the natural hormonal balance of women.
• LAM may offer protection against breast cancer in later years.
Disadvantages of LAM
• There are very high failure rates for women who don’t use LAM correctly and consistently.
• LAM can be relied on for only six months.
• LAM does not protect against sexually transmitted infections.
• Breast-feeding on demand may be difficult within many lifestyles.
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Rapid orgasm is rare in women, but it does occur. It happens when a woman reaches orgasm more quickly than her partner and then loses interest in continuing sex play. It is so rare that it is not included in the diagnostic manual for psychotherapists.
Men who have premature ejaculation ejaculate before they want to. They are unable to control their responses to the stimulation that triggers ejaculation. Some may ejaculate at the sight of their partner undressing, before sex play even begins. Also called early ejaculation, this is the most common sexual dysfunction among men. Up to 30 percent of men experience early ejaculation at some time. Premature ejaculation is often difficult for a man’s partner because it may deprive her or him of continuing sex play and orgasm. Men who have early ejaculation may feel guilt and anxiety and may at some point decide to avoid sexual contact.
Fear and anxiety about sex, alcohol and drug use, depression, and other psychological conditions may cause premature ejaculation. Early anxiety can be treated with psychosexual therapy. Open communication and increased focus on sensation during sex play can help men delay ejaculation.
Some partners are taught to use the squeeze technique: The man’s partner brings him to full erection manually. As he approaches ejaculatory inevitability, his partner squeezes his penis between thumb and forefinger, just below the glans. The partner applies considerable pressure to the penis for 10 to 30 seconds until the erection is reduced by 10 to 30 percent. The penis is released for 30 seconds before being manually brought to erection again, and again, just before ejaculation, the penis is squeezed and pressure is applied. This procedure is used until the man can go 15 to 20 minutes before ejaculation. After several days of this therapy, in which the man postpones ejaculation for more than 15 minutes, he is allowed to insert his penis into his partner.
Many men will experience early ejaculation from time to time. It is important that we accept this as a normal part of our sex lives and not let ourselves become so anxious that we make sex less pleasurable for us than it might be.
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Most survey data available on psychosexual development in adolescence concern the onset of coital behavior. In the Kinsey studies, the majority of adolescents had their first coital experience years later than their first ejaculation or menarche, and the average female had this experience later than the average male: by fifteen years of age, 24% of the males and 3% of the females were coitally experienced. Surveys of young American teenagers have been provided more recently by Sorensen, Miller and Simon, and Vener and Stewart. For the age group thirteen to fifteen, the incidence of coitus ranged from 9 to 44% in males and from 7 to 30% in females. The methodological problems that may account for the discrepancies have been discussed by Hopkins. Similarly low rates have been published by Schofield on English teenagers, by Schmidt and Sigusch for German samples, and by Asayama for Japanese adolescents. These data, together with the report by Jessor and Jessor on late adolescents and the numerous studies on college students (summarized by Hopkins) make it clear that for most white populations studied, the initiation to coital activity occurs after age sixteen, after the major somatic-endocrine changes of puberty have occurred and well after reproductive capacity has been attained.
Many factors other than gender have been shown to affect age at first coitus. In North America, the most influential one seems to be race: for instance, Zelnik and Kantner found that of fifteen-year-old women, 38.4% of blacks but only 13.8% of whites were coitally experienced. The authors had shown in an earlier sample (Kantner and Zelnik) that the difference remains largely the same when the socioeconomic level is controlled. Socioeconomic level has a less consistent effect on coital initiation. It seems that adolescents from lower socioeconomic strata are sexually active earlier than others (e.g., Kinsey and others; Miller and Simon). However, recent data on late adolescent or college student samples showed conflicting results which have been critically discussed by Hopkins.
More pertinent to psychoendocrine research are data on acceleration. As mentioned earlier, the age at puberty in terms of menarche has consistently regressed over the last 150 years. Is there a similar shift in coital activity? Within the last two decades or less, such shifts have been demonstrated, by Vener and Stewart, Zelnik and Kantner, Schmidt and Sigusch for Germany, and Asayama for Japan. More of a shift seems to have occurred in females than in males so that the sex difference is shrinking. Such changes, however, appear to be of relatively recent origin. Nothing suggests that there has been a consistent regular decline of age at first coitus which would parallel the acceleration of puberty over the last 150 years mentioned before.
Although it is obvious that strong social pressures have influenced and are still influencing coital initiation during adolescence, sexual behavior that is less subject to interference may be more closely related to puberty. One example is masturbation in males. If masturbation is closely related to physical maturation, age at onset should follow the acceleration of puberty, and this was shown by Asayama for Japanese adolescents. Romantic love is another variable that is generally less prohibited than (premarital) coitus. Broderick surveyed 1,000 middle-class children and adolescents from age five to eighteen years. He found that from the fifth grade (ages ten to eleven) on between 40% and 60% of both boys and girls reported having been in love or being in love. Kephart made a recall study of 1,079 young people. Males reported their first infatuation at age thirteen and a half, their first love affair at seventeen and a half; the corresponding figures for females were thirteen and seventeen years. The age range from eleven to thirteen years coincides with Tanner stages 2 through 4 in typical girls and Tanner stages 2 and 3 in boys. It is tempting to speculate that the association of the development of romantic love with pubertal stages may be more than accidental.
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Boy babies are sometimes born with erections, and girls demonstrate vaginal lubrication almost at the start. In a study of nine male babies of ages three to twenty weeks, tumescence (penile erection) was observed at least once daily in seven of the nine. Individual responses varied greatly from five to forty erections per day. Tumes-cence often was accompanied by restlessness, fretting, crying, stretching, and flexing the limbs stiffly. The behavior following the detumescence was in the nature of playful activity or relaxation. Parents often report having observed erections in infant boys.
Pelvic thrust movements in male and female infants eight to ten months old appear to occur as an expression of affection in which the baby holds onto the parent, nuzzles the parent, and rapidly thrusts and rotates the pelvis for a few seconds (Lewis and Kagan). It appears to be more an evidence of pleasure, an ecstatic rather than an erotic mood. This kind of behavior diminishes when holding the infant closely decreases as the infant becomes ambulatory. Pelvic thrusts have also been observed among primate infants; infantile sexual behavior in all mammals is perhaps the rule.
A newborn infant is responsive to external stimulation of the genital area. A gentle touch, or the rubbing of clothes or bed coverings, seems to attract attention. If the infant has been active or restless or is having a crying spell, genital stimulation appears to quiet and relax. In the third or fourth month of life, genital stimulation is sometimes accompanied by smiling and making a few soft sounds. The boy baby from birth is likely to have an erection on such occasions. Girls show similar responsiveness. Internal sources of stimulation, such as a full bladder or a full bowel, also produce sensory reactions. These reactions are less likely to be accompanied by signs of pleasure and relaxation than are reactions to external stimulation.
Orgasm has been reported for a four-month-old female baby and has been observed in boys as young as five months.
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Recent literature suggests that fathers may influence their sons’ psychosexual development more strongly than mothers do. It has been concluded that homosexual men’s reports of their childhood relationships with their fathers tend to be more consistent than their reports about their mothers. Indeed, a great number of investigations have found that homosexual men describe negative relationships with their fathers. In one clinical sample, male homosexual patients were described by their psychiatrists as less likely than heterosexual patients to have respected their fathers, to have spent much time with them, or to have been their fathers’ favorite child. Although the psychiatrists described a minority of their patients, whether homosexual or heterosexual, as having had hostile, detached fathers, this description was more common for the homosexuals. The same findings were reported by another researcher comparing nonclinical samples of homosexual and heterosexual men. In other studies, the fathers of homosexual males have been described as autocratic and brutal, abusive and rejecting, unloving, critical and impatient, absent or aggressive, and distant.
Such adverse father-son relationships, according to psychoanalytic theory, may interfere with a heterosexual resolution of the “Oedipal struggle.” In this crisis of early childhood, such theory maintains, the boy becomes a jealous rival of his father and wishes to take over his privileged position as master of the house and the chief object of his mother’s affection. However, in the “normal” developmental pattern, the boy fails to realize this ambition because his father is too powerful to be summarily displaced; from this defeat, the boy develops a sense of fear and inferiority to his father, which he deals with by identifying with this powerful figure and eventually transferring his sexual interests to other females.
This developmental pattern is thought to require a father-son relationship characterized by warmth, affection, and mutual respect. Such a relationship presumably lays the groundwork for a boy’s identifying and feeling comfortable with his father, and later with other males. According to this view, a boy who considers himself a “chip off the old block” is likely to feel relatively certain about his masculine identity and un-threatened in his relationships with other males. A boy’s close relationship with his father has been found to increase his self-esteem and thus to contribute to feelings of confidence in his relationships with both males and females outside the home.
Opposite circumstances have been posited for prehomosexual boys. It has been suggested that these boys’ relationships with their fathers are often characterized by distance, antagonism, fear, and mutual low regard—qualities that make it hard for a boy to identify with his father or, in turn, to develop a strong masculine identity. It has been suggested that such boys need to assure themselves that other males consider them worthwhile; thus, homosexual activity has been interpreted as a male’s attempt to feel less threatened by other males and/or to find a father-surrogate. In terms of the “Oedipal struggle,” rather than competing with his father for his mother’s affections, the prehomosexual boy has been viewed as competing with his mother for his father’s love and as emulating his mother in order to win favor with his father, whom he basically fears.
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