Improving Your Sex Life

Revive Her Drive

Be ready to go through a complete transformation in the way that you think and feel about having sex with your wife or girlfriend! Revive Her Drive is like a Cheat Sheet to woo your woman the way she secretly wants you to, and simply cant express. The solution is based on female-friendly, easy-to-learn strategies that she will love! How nice will that moment be when shes lying in your arms, happy and spent, and she actually Thanks You for helping her to rediscover her sensual self? Shell be grateful that you, Her Man, now that you have the vision and skill to guide her into new, electrifying experiences even if she fights you or resists you now. Women Are sensual creatures. We women want pleasure, intimacy, connection, sensation as much as you do! Ill prove this to you. Once you know how to captivate her, you can turn her into a pleasure-seeking device within 24 hours. Getting that kind of responsiveness is the feedback you need to feel confident this program is working. Discover how Robert rekindled his relationship with Lauren using the tools within Revive Her Drive by watching this short presentation that lays out the whole strategy youll use to transform your intimate life into one of passion, surrender and fantasies-come-true. Read more here...

Revive Her Drive Summary

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Contents: Ebook
Author: Tim and Susan Bratton
Official Website: reviveherdrive.com
Price: $197.00

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Highly Recommended

The author presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this manual are precise.

Purchasing this e-book was one of the best decisions I have made, since it is worth every penny I invested on it. I highly recommend this to everyone out there.

Sexual Feelings and Relationships

I don't know what's the matter with me. My brain is always stuck on thinking about sex and it gets me into trouble. Maybe it's because I hit puberty earlier than most of the other guys in my grade. I'm always horny in school and then I'm thinking about Will I jerk off when I get home or will I be able to resist it Some days I can resist, but usually I have to do it as soon as I get home from school. Then I take a nap. At night I try to do my homework, but usually I go on line to IM with my friends and then I spend an hour or two surfing the porn sites and getting myself off again. Afterwards I feel stupid for being so messed up and then I just don't feel like doing any homework, so I just listen to some music and go to sleep. Many adolescents (and adults) struggle with sexual preoccupations and with feelings of guilt over their actual or imagined sexual activities, but those with ADD syndrome often report much more difficulty in managing these thoughts and emotions than do most of...

Orgasm and Ejaculation

The orgasm,36 or climax, is a short but intense reaction that lasts 3 to 15 seconds and usually is marked by the discharge of semen. The heart rate increases to as high as 180 beats per minute, blood pressure rises proportionately, and the respiratory rate becomes as high as 40 breaths per minute. From the standpoint of producing offspring, the orgasm swelling most significant aspect of male orgasm is the ejaculation37 of semen into the vagina. Somatic motor impulses leave the third and fourth sacral segments of the cord and travel to the bulbospon-giosus, ischiocavernosus, and levator ani muscles. The bulbospongiosus, which envelops the root of the corpus spongiosum, undergoes five or six strong, spasmodic contractions that compress the urethra and forcibly expel the semen. Most sperm are ejected in the first milliliter of semen, mixed primarily with prostatic fluid. The seminal vesicle secretion follows and flushes most remaining sperm from the ejaculatory ducts and urethra. Some...

Orgasm

Late in plateau, many women experience involuntary pelvic thrusting, followed by 1 to 2 seconds of suspension or stillness preceding orgasm. Orgasm is commonly described as an intense sensation spreading from the clitoris through the pelvis, sometimes with pelvic throbbing and a spreading sense of warmth. The orgasmic platform gives three to five strong contractions about 0.8 seconds apart, while the cervix plunges spasmodically into the vagina and into the pool of semen, should this be present. The uterus exhibits peristaltic waves of contraction it is still debated whether or not this helps to draw semen from the vagina. The anal and urethral sphincters constrict, and the paraurethral glands, which are homologous to the prostate, sometimes expel fluid similar to pro-static fluid. Tachycardia and hyperventilation occur the breasts enlarge still more and the areolae often become engorged and in many women a reddish, rashlike flush appears on the lower abdomen, chest, neck, and face.

Acquired immunodeficiency syndrome

Generally the most severe but neurological problems such as dementia resulting from HIV infection of the brain cells can also occur. The disease is almost always fatal. It is generally transmitted through blood and body fluids, usually through unprotected sexual intercourse, but vertical and or perinatal transmission is also very common. AIDS is prevalent among injecting drug addicts and in patients receiving blood transfusions. It can be partly controlled by antiretroviral drugs such as AZT (azidothymidine) or non-nucleoside reverse transcriptase inhibitors such as nevirapine combined with protease inhibitors (See HAART therapy), but the side-effects of the drugs are not negligible.

Nurse Practitioner Chelsea and Westminster

Cindy qualified as a Registered General Nurse in 1987. Following qualification she worked as a staff nurse in acute medicine for two years and then from 1989 to 1996 worked as a staff nurse in Accident and Emergency. In 1996 Cindy moved into Sexual Health nursing, and in 1999 became a Nurse Practitioner at The West London Centre for Sexual Health. In 2000 she undertook the MSc in Nursing and Midwifery (Advanced Nurse Practitioner pathway) and obtained a Post Graduate Diploma in 2003. Cindy also took the role of Charge Nurse at the West London for a year in 2001. Since working in Sexual Health Cindy has been involved in several projects, including being the Lead Nurse for an Outreach Clinic for vaccinations and syphilis screening for men who sell sex, and also setting up a clinic for women who have sex with women. She takes an active role in staff development and facilitates teaching and assessing in advanced asymptomatic screening and sexual history-taking. At present Cindy is an...

Transmission of the virus

HIV has been isolated from semen, cervical secretions, lymphocytes, cell-free plasma, cerebrospinal fluid, tears, saliva, urine, and breast milk. This does not mean, however, that these fluids all transmit infection since the concentration of virus in them varies considerably. Particularly infectious are semen, blood, and possibly cervical secretions. The commonest mode of transmission of the virus throughout the world is by sexual intercourse. Whether this is anal or vaginal is unimportant. Other methods of transmission are through the receipt of infected blood or blood products, donated organs, and semen. Transmission also occurs through the sharing or reuse of contaminated needles by injecting drug users or for therapeutic procedures, and from mother to child. Transmission from mother to child occurs in utero and also possibly at birth. Finally, the virus is transmitted through breast milk.

Principles Of Sexual Dysfunction Therapy

After assessment of the exact nature of the dysfunction and possible etiological factors, two basic steps mark the early stages of therapy managing anxiety and education. Quite often, the partners find it difficult to discuss sexual problems with each other or with the therapist, and the underlying lack of sexual education may well contribute to this and to sexual anxiety. Simple reading materials often allow the therapist to discuss problems, offer solutions, and peg the treatment planning. This basic education is often crucial in sex therapy. Anxiety management is usually carried out in a number of ways from physical muscle relaxation to yoga training or using tai chi or the Alexander technique. A valuable part of this anxiety management is the process of despectatoring, which encourages individuals to get away from focusing on the sexual act and instead allowing relaxation in their physical and intimate contact. If the therapist discovers that there are underlying angry or...

All patients complaining of erectile dysfunction should undergo a full clinical examination including examination of

This can be successful in almost two-thirds of the diabetic patients treated, which is rather less than in non-diabetic people where even higher rates of success have been reported. It is taken half to one hour before sexual activity (initial dose 50 mg subsequently 50 to 100 mg according to response not to be used more than once in 24 hours). Sexual stimulation and foreplay are necessary for it to be effective. It is contraindicated in those taking nitrates, those whose blood pressure is less than 90 50 mm Hg, after recent stroke or myocardial infarction, or in other situations where sexual activity is inadvisable. There are several potential side effects which are rarely troublesome (see BNF).

Surgical Procedures

The selection of patients for sexual surgery is problematic because of significant areas of disagreement on the indications and the success criteria of various procedures. In spite of surgical intervention, underlying psychological factors often need to be taken into account. Some of these have been identified as poor sexual communication, lack of foreplay, and loss of interest. Preoperative counseling as part of the assessment should help in ruling out some of these problems.

Genital Anomalies Fertility and Sexual Problems

Patients with ARM have a high incidence of genital anomalies. Genital anomalies occur in 26 of boys 89 , the most common being undescended testes and hypospadias. The most common in girls are vaginal and uterine septation anomalies and vaginal agenesis 90 . Genital tract function has been reported to be impaired in almost half of patients because of vaginal scarring 90 . In sexually active females this often causes coital problems Matley et al. 91 found dyspareunia in four of nine adult females who had undergone repair of a vestibular anus. Vaginal scarring may interfere with deliveries, and today most females with significant ARM deliver by cesarean section 91,92 . Vaginal deliveries and pregnancies may also worsen fecal continence in patients with a history of vestibular fistula 91,93 . Late gynecological problems are especially common in patients with cloaca. A high percentage of postpubertal females with cloaca develop obstruction of some part of Mullerian structures, with...

Gay Lesbian and Bisexual Adults

These three groups present with the same varieties of sexual dysfunction discussed above, and the treatment plans, whether physical or psychological, are about the same. However, there are some additional factors that need to be taken into account. The first of these is the fact that, even though a gay or lesbian individual is seeking help, this does not necessarily mean that they are publicly out and that everyone knows of their sexual orientation. A second factor is the common use of high-tech sex toys, pornography, and in men, fist-fucking, sadomasochistic practices, and water sports (urination). Lesbians, on the other hand, may well have feminist views and may have political views on sexual intercourse that may appear to be at odds with those of the therapist. Furthermore, views on pornography, sexual exploitation, and the existence of a patriarchal society may well contribute to models of behavior and expectations of treatment at variance with those of heterosexual women. Some...

Alcohol dehydrogenase ADH

AIDS the acquired immunodeficiency syndrome, a disease caused by the human immunodeficiency virus (HIV). This virus attacks lymphocytes of helper T subclass and macrophages. The depletion of these cells makes the patient susceptible to pathogens that would easily be controlled by a healthy immune system. The infection is transmitted by sexual intercourse, by direct contamination of the blood (as when virus-contaminated drug paraphernalia is shared), or by passage of the virus from an infected mother to her fetus or to a suckling baby. AIDS was first identified as a new infectious disease by the U.S. Centers for Disease Control and Prevention in 1981. See Appendix C, 1983, Montagnier and Gallo. HIV, lymphocyte, retroviruses.

Why Has The Person Come For A Checkup

Your initial questions should identify why the person has come for a check-up. Be aware that there may be a subtext to their visit careful listening will help you identify if there are other concerns (Law & McCoriston, 1996 Presswell & Barton, 2000). These may include sexual dysfunction therefore follow up throwaway lines or ambiguity - 'So does this cause impotence ' Your response may be 'Is impotence or problems with having sex worrying you '

Recent Sexual History

'When did you last have sexual contact with someone ' (Describe briefly, for example the week as x 52, the month as x 12 this helps you ascertain the incubation periods for infections as well as the window period for HIV and hepatitis.) 'Was this person male or female ' This will guide your questioning and assist you in the risk assessment. Please remember that if the client is female and having sex with another woman this doesn't necessarily mean that they are not at risk that other woman may have had male relationships in the past and may have acquired chlamydia, genital warts or HIV. The use of shared sex toys may also be a risk factor. 'When did you last have sexual contact with someone different ' (Repeat as above.) Be aware that some clients will have more than one regular partner. This can be a cultural issue for example some people will have a person who has borne their child that is their baby mother, but she may not be the only regular sexual partner. This is important in...

Does Viagra help with impotence in MS

The physical problem of erectile dysfunction is now openly discussed and is recognized commonly in otherwise healthy men. This change in the public attitude has helped men with MS accept this aspect of sexual function when it occurs and embrace the use of one of the approved drugs for erectile dysfunction. Viagra, Levitra, and Cialis appear to be at least as useful in men with MS as they are in otherwise normal men. Some studies have suggested that these drugs may also Orgasm be helpful in women having difficulty achieving an Sexual climax. orgasm. In any case, these medications should be used Physical limitations affect men more than women in the sex act. The female partner can often compensate for movement difficulties if they limit sexual performance in men. A willingness to experiment is healthy.

Achieving Sexual Health The Role Of Health And Social Care Professionals

It can be seen from the above discussion that helping people to achieve sexual health is a vital part of the role of health professionals, but at the same time an extremely challenging one. Health professionals need a range of knowledge and skills to be able to engage with individual clients and groups in the promotion of sexual health. Probably the most crucial is the ability to deal with sensitive, confidential and personal issues and to be able to discuss aspects of clients' lifestyle and behaviours that are not usually shared outside a close sexual relationship. It is important that health professionals involved in sexual health promotion have a broad understanding of the theory and practice of health promotion and the current emphasis being placed on this by the current public health policy agenda.

Lets examine this further

In the context of the recent cases where individuals have been found guilty of knowingly passing on the HIV virus, let us explore the legal and professional issues that may arise for the practitioner. First, let's examine the potential duty of the healthcare worker who is aware of the HIV status of their patient. What obstacles stand in their way in breaching confidentiality, and what, if any, may be the advantages Taking recent professional experience into account, there have been examples of situations where this would seem to be the right thing to do in order to protect a sexual partner from these diseases.

Posterior Lobe Hormones

Contract, thus contributing to the labor contractions that expel the infant. In lactating mothers, it stimulates musclelike cells of the mammary glands to squeeze on the glandular acini and force milk to flow down the ducts to the nipple. In both sexes, OT secretion surges during sexual arousal and orgasm. It may play a role in the propulsion of semen through the male reproductive tract, in uterine contractions that help transport sperm up the female reproductive tract, and in feelings of sexual satisfaction and emotional bonding.

Effects Of Child Sexual Abuse

The impact of sexual abuse depends upon many factors the offender-victim relationship, the particular sexual act(s), the frequency and duration of the sexual abuse, the nature of inducements to participate and admonitions regarding disclosure, the response of non-abusive caretakers to disclosure, and the personality and personal history of the child. Research documents that the most important element in the child's recovery is having a caring and concerned, nonoffending parent. Thus, being believed and supported makes a great deal of difference in the long-term well-being of the victim.

Sexual Dysfunction Therapy

Erectile Disorders Problems in obtaining or sustaining a sufficiently strong erection for sex. Orgasmic Disorders Problems in achieving a climax in sex. SEXUAL DYSFUNCTION has been classified according to the four phases of sexual activity in both males and females. At each stage the individuals can suffer from high or low levels of activity and additional physical problems and pain at various stages during these phases.

Risk Factors for Transmission Among Homosexual

Winkelstein, Padian, Rutherford, and Jaffe (1989) review studies of factors affecting the chance of transmission among homosexual men. The earliest studies compared patients with AIDS to controls without AIDS. Marmor, Friedman-Kien, Laubenstein, et al. (1982) conducted a case-control study based on 20 histologically confirmed cases of Kaposi's sarcoma among homosexual men seen at the New York University Medical Center between March 1979 and August 1981 and on 40 controls matched to cases on age and race and selected from the Manhattan practice of a physician treating homosexual men. Risk was associated with level of sexual activity in the previous year, with a history of mononucleosis and of sexually transmitted diseases, and with the use of recreational drugs. A multivariate logistic model included numbers of previous sex partners and lifetime exposures to amyl nitrite. Despite the suggestion from the multivariate regression that exposure to nitrites might have an etiologic role for...

Reports of Health Events

For some public health purposes, however, effective action requires additional detail on each case. For this reason, supplemental data collection systems have been developed for some of the diseases involved in the NNDSS. Such supplemental systems are sometimes less comprehensive in terms of the population represented but provide more detailed information on characteristics of the occurrence of disease (CDC 1991). For example, cases of hepatitis are reported weekly to NNDSS for publication in the Morbidity and Mortality Weekly Report (MMWR). In addition, the Viral Hepatitis Surveillance Project collects data on specific risk factors for different types of viral hepatitis in selected geographic areas. These data have been used to evaluate the importance of behavior associated with sexual activity and drug use as risk factors for transmitting hepatitis type B and to target educational and vaccination programs. Other uses of data may require the ability to identify the patient whose case...

Discussion Challenges To Effective Health Promotion

Vital to any discussion on sexual health promotion is the complexity of sexual relationships and issues of power and trust within those relationships. Aggle-ton and Tryrer (1994) argue that for health promotion to be effective it is necessary to address the wider issues of oppression, gender inequalities, distribution of power and cultural expectations. Discussion has already alluded to the fact that sexual health decisions normally involve more than one person. Often individuals do not freely make choices about their own sexual health, for example over condom use. This is particularly true of young women's difficulties in negotiating safer sex, in which the partner's preference of method is important. Holland et al. (1990) found that young women often had a negative view of condoms as a form of contraception, as they were unacceptable to their current partners, while using the contraceptive pill became a symbol of their 'love and trust' for their partners. At the other end of the...

What Is Sexual Health

Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled (WHO, 2002 internet). In this definition the WHO strives to acknowledge the complexities of sexual relationships and the importance of respect and consideration for others in achieving individual sexual health. In considering absence of disease, freedom from coercion and violence and respect of all persons the definition allows us to consider sexual health from a human perspective. This definition is important in that it recognises the gender and power conflicts that exist in...

Routes of Infection and Natural History of Infection with HBV

In certain geographic regions, including Asia, the South Pacific region, the Middle East, and Sub-Saharan Africa, as well as in the indigenous population of Alaska and the Arctic. In Western countries, HBV is most common among immigrants from endemic areas, injection drug users, hemodialysis patients, men who have sex with men, and promiscuous heterosexuals. The risk of chronic infection relates largely to the age at exposure. Most adults and adolescents infected will experience an acute infection, which is generally symptomatic but may be subclinical.

Amita GuptaMD and Robert C BollingerMD MPH

Intestinal parasites are important causes of morbidity and mortality, particularly in resource poor settings. Disease accompanying these infections can manifest as a nutritional disturbance. Reduced food intake, impaired digestion, malabsorption, anemia and poor growth rate are among the many possible sequelae that can occur. in the United States and other developed nations, intestinal parasites are most prevalent among returning travelers, immigrant groups, and immunocompromised hosts. Domestic infection occurs in settings such as community waterborne outbreaks, persons who drink untreated stream water, children and employees of daycare centers, men who have sex with men, and persons eating raw or undercooked beef, pork, or fish.

Hivassociated Squamous Cell Cancer Of The Cervix Epidemiology of HIVAssociated Cervical Cancer

There have been many studies that have reported the prevalence of AIN among HIV-infected men and women. Sixteen studies demonstrated that between 41 and 97 of HIV-infected men are found to have anal dysplasia on anal pap smear screening.320-333 Palefsky et al.334 also found that the relative risk (RR) of developing high grade squamous intraepithelial lesions (HSIL) was 3.7 (95 CI 2.6-5.7) for HIV-positive men who have sex with men (MSM) compared to HIV-negative MSMs. In addition, five studies have shown that between 14 and 28 of HIV-

Classification Of Sexual Dysfunction

Orgasm Orgasmic dysfunction Female sexual dysfunction includes sexual desire disorders along with impaired arousal, orgasmic disorder, and vaginismus. Females may perceive their sexuality differently, and their sexual activity is, in part, culturally defined. This definition impacts upon the way in which women understand their own sexuality and whether they can adjust their expectations of their sexual functioning. Female sexual dysfunction may be due to early childhood experiences, or to later trauma, including sexual abuse, childbirth, and infertility, among others. Myths about sexual activity and sexual functioning may well affect both males and females. In males, while orgasm and emission are normally linked, they can be separated, because in the latter phase organic muscle contraction and emission are responsible for ejaculation. Male sexual dysfunction includes premature ejaculation, retarded ejaculation, Various psychological factors that contribute to sexual dysfunction in...

Domestic Violence Intervention Programs for Teenagers

The social action part of the program actively engages group members in working together to identify and to challenge some aspect of violence in their own community. First, there is a series of exercises aimed at teaching group members about resources available to teenagers, men, and women in their community. Next, group members develop a social action or a fundraising activity in which they all participate. Examples include setting up a display about stopping sexual assault in a shopping mall and selling t-shirts to raise funds for a local battered women's shelter. In this way teenagers put their skills to use on the broader community level. Along the way they learn to respect one another and themselves, to think differently about sex roles and family roles, and to develop healthier relationships as they work together to stop violence against women.

Inventions That Changed The World

An avalanche of advice literature, especially texts dealing with health and diet, was a major product of the print revolution. Popular texts in the vernacular told people what foods, drugs, and spices were ''good'' or ''bad'' for their health, explaining proper food choices in terms of humoral and medical theories. Advice on hygiene still discussed the Galenic rules of health or regimen in terms of the six non-naturals food and drink, air or the environment, exercise and rest, sleep and waking, evacuation and repletion, and the passions of the soul or the emotions. Similar formats were adopted by texts that gave advice to wealthy readers about sex, clothing, cosmetics, health, family life, managing pregnancy and childbirth, wet-nursing, child rearing, and so forth. Medical writers had to find ways of adapting medical theories to New World plants such as tomatoes, potatoes, and tobacco that were being used as foods and drugs. Written advice could get very detailed without causing...

Protection Against Other Liver Diseases

Patients with chronic HBV infection should be counseled to minimize alcohol use, although the safe level of consumption has not been defined. It is important that patients be advised to have household and sexual contacts tested for both HBsAg and HBsAb to identify both those who are infected and require further examination, and those who are susceptible to infection. Until HBsAb is documented in sexual partners, either via natural infection or vaccination, safe sex techniques must be employed. Hepatitis A (HA) vaccination is advised in all patients with chronic liver disease. Generally, screening for HA antibody is not cost effective before vaccination but may be in selected patients with a high likelihood of prior HA infection, such as those born in developing countries.

Neural Control Of Behavior In Drosophila

Studied two mutations affecting mushroom body structure and found that these mutations impaired olfactory conditioning. deBelle and Heisenberg (1994, 1996) reported that both genetic defects and treatment with hydroxyurea cause the loss of mushroom body Kenyon cell fibers, which in turn causes an inability of adult flies to respond to associative odor learning. In addition, a distinction has been found between olfactory memory acquisition and memory recall. Dubnau et al. (2001) and McGuire et al. (2001) have shown that synaptic transmission in the mushroom body is necessary for olfactory memory recall but not for memory acquisition and storage. Also, male-female sex behavior has been associated with a feminizing transgene that is expressed in the pars intercerebralis (Sylvain et al. 2000). Adult trans-genic males act as females when the transgene is present in a cluster of pars intercerebralis cells. In all of these observations the behavioral change is associated with a structural or...

Hiv Pretest Discussion

The HIV pre-test discussion has four main functions. The first of these is to assess an individual's previous and current ongoing risk of acquiring HIV. It can also function as a platform to educate sexually active people about their level of risk in order to avoid only future acquisition of HIV. Moreover, it can help to manage the psychological anxieties arising from the fear and knowledge of HIV. In addition, it can also normalise the process of HIV testing within the context of a sexual health screen, thereby reducing the stigma associated with HIV testing and HIV-positive people.

How does MS affect sexual function

Patients and physicians in the past rarely discussed sexual function and performance despite its central role in life. This was especially true when illness other than heart disease was at issue. Sexual relationships are a major bond between married couples, and the new frankness about these issues promises to benefit particularly MS patients greatly. There are a number of pertinent issues in this regard, many of which are equally important to healthy persons. The most common sexual problem affecting both men and women in good health is the lack of libido (sexual interest or sexual drive). Psychologic stress arising from interpersonal relationships and work is probably the most common single cause for this it is obviously much more of an issue in young adults affected by a major health problem. The resultant uncertainties that naturally arise in these situations contribute to this greatly. The actual diagnosis of illness may induce acute stress, which can precipitate sexual difficulty...

Vacterl Syndrome Life Expectancy

Vacterl Syndrome Life Expectancy

And will require sperm extraction techniques. The extent of these problems in the adult ARM population is difficult to assess as many of the long-term outcome studies are carried out to include a paediatric population, where questioning about sexual activity and fertility would be inappropriate. Therefore, cohorts for late follow up have to be recruited from a variety of sources, including patient support groups, which may give an overestimate of late problems. Furthermore, research tends to concentrate on outcomes for faecal continence. Even when sexual function is considered, it seems to be little more than a footnote, sometimes without distinguishing between genders. In spite of improved surgical techniques, there is still an appreciable amount of morbidity associated with ARM. The consequences of a serious medical condition combined with protracted and repeated hospital admissions will undoubtedly have an effect on both the patients and their families. Patients with ARM have been...

Trichomonas vaginalis

A red appearance of the cervix is not necessarily pathological, but may be due to the outward movement of the transformation zone under the influence of high circulating levels of oestrogen, particularly in young women or those taking the combined oral contraceptive pill. The soft, mucus-producing columnar cells that usually line the endocervical canal are seen on the outside of the cervix this is known as 'ectopy' or 'an ectropian', and is a normal physiological variation. For some women, however, it may be associated with increased physiological discharge or with contact bleeding (for example, after sex). Information should be given, which may provide reassurance however, the discharge may be particularly heavy and problematic for some women (for example requiring frequent changes of sanitary protection). Although a normal variation, symptoms can sometimes be improved through treatment with cold coagulation, which (paradoxically) uses heat to the cervix to destroy the cells...

Entamoeba histolytica and Entamoeba dispar Amebiasis

Entamoeba are present worldwide but are most prevalent in tropical and subtropical areas, particularly under conditions of poor sanitation, malnutrition, and crowding. An estimated 500 million persons worldwide are infected with entamoeba 90 are E. dispar and 10 are E. histolytica. E. dispar does not require treatment but labs rarely differentiate between these two species. Humans are the only hosts for entamoeba. Transmission occurs through ingestion of cysts from fecally contaminated food or water person-to-person and sexual transmission can also occur. Although entamoeba infections occur frequently among men who have sex with men, these infections are usually due to E. dispar. Diagnosis of intestinal amebiasis is made either by detecting the antigen or the organism in stool.

Hormones Secreted By The Pituitary And Their Target Organs

The posterior pituitary, or neurohypophysis, stores and secretes a hormone called oxytocin. This hormone has many functions. It causes milk letdown during nursing and has multiple functions as a neurotransmitter in the brain. It is secreted during orgasm in the female and is also released when the infant is nursing. Oxytocin also has an eifect on kidney water balance. The other hormone stored in the neurohypophysis is antidiuretic hormone or ADH. It is also known as vasopressin. It causes absorption of water from the collecting tubules of the kidney decreasing the volume of water in urine.

Vaginal Reconstruction

Vaginal Reconstruction

The problem of the woman with an absent or inadequate vagina is unresolved. Much of the reported work has been on patients with intersex conditions, but the same principles apply to the vaginal anomalies associated with ARM. A variety of techniques for reconstruction are available. None has been shown to produce an ideal substitute for the natural organ and it seems unlikely that any would have the same sexual sensation as the natural vagina. In an extensive review of the literature, it was found that follow-up assessment was usually confined to the observation that penetrative intercourse was possible, with no attempt to measure its quality 22 . There was little critical evaluation of female sexuality. In Pena's series there were 22 females over the age of 14 years. Only seven were considered to be gynaecologically normal. Six had a small or absent uterus and nine had an obstructed uterus at a variety of levels 7 . It is these patients who present a major surgical challenge. Although...

Hypothalamic and pituitary hormones

Gonadotrophin-releasing hormone (GnRH) is a decapeptide initially joined to a 56 amino acid peptide called GAP as part of a larger molecule. As a dual structure it is stored, as granules, within the median eminence. When the environment is appropriate it splits into GnRH and GAP and is discharged as such down the hypophyseal portal vessels to the anterior pituitary, where it binds to receptors on the gonadotrophe of the pituitary (Strauss et al., 1979). Eighty per cent of the GnRH so released passes along this route the remaining 20 passes back through the median eminence and on to the higher centres of the brain driving sexual behaviour (Pozor et al., 1991). GnRH is secreted in both a pulsatile and continuous (tonic) fashion. Pulse frequency during periods of sexual rest are 1-2 per day, both within and outside the breeding season. However, within the breeding season the tonic levels of GnRH are significantly elevated in the absence of melatonin inhibition. Sexual activity increases...

Interactions Between the Nervous System and Other Organ Systems

Nervous system regulates sex drive, arousal, and orgasm secretes or stimulates pituitary release of many hormones involved in menstrual cycle, sperm production, pregnancy, and lactation Sex hormones influence CNS development and sexual behavior hormones of the menstrual cycle stimulate or inhibit hypothalamus

Acute Salpingitis And Pelvic Inflammatory Disease Pathogenesis and Microbiology

PID usually begins with cervical infection that is caused by C. trachomatis, N. gonorrhoeae, or both. Acute salpingitis and PID occur after extension of the infection from the lower parts of the female genital tract to higher structures. Organisms infecting the cervix can spread to involve the uterus and fallopian tubes in two ways by causing a transient endometritis that extends to involve the endosalpinx or by reaching the tubes via lymphatic spread. Acute salpingitis and PID may be gonococcal or nongonococcal, according to the presence or absence of associated endocervical gonorrhea. Acute pelvic salpingitis and PID is predominantly a disease of young sexually active nonparous females.

A Closed Twocompartment Model 921 Model Definition and Properties

Suppose a large number of individuals, jV0, are engaging in behaviors that can transmit HIV, and that the chance of transmission per infected partner contacted is J. To be precise, we are assuming that all contacts with a partner are concentrated into an instant and that fi is the probability that a susceptible partner is infected by having a partnership with an infected partner, without regard to the number or type of sexual acts during the partnership. Suppose the average rate of formation of new partnerships is i per unit time and that each person is equally likely to form a new partnership with any other person. Ifj ( ) is the fraction infected with HIV at time t, then in the time interval (t, t + dt) each susceptible individual is expected to form partnerships with ny t)dt infected individuals. The corresponding chance of infection is fi iy(t)dt. Assuming that the hazard of death among infecteds is constant at a, so that

Axis II Personality Disorders and Mental Retardation

By pervasive, it is meant that the behavior in Personality Disorders is seen across many different situations in the person's life. Whereas people without personality disorders may demonstrate some features of certain personality disorders in restricted situations (e.g., one is extremely suspicious of a difficult coworker e.g., one doubts the fidelity of a spouse or sexual partner after a previously difficult and unfaithful relationship), such persons do not do so across situations (e.g., with coworkers, with spouse or partner, and with neighbors).

Approaches To Health Promotion

A further limitation of approaches focusing on the individual is the tendency to concentrate on 'medical' models of health promotion such as sexual health screening or preventive treatment. Imrie et al. (2005) argue for a more positive approach to health promotion for men who have sex with men than purely concentrating on clinic-based sexual health interventions such as sexual health screening and the treatment of sexually transmitted disease. They point to the fact that many men who have sex with men and who have HIV have a higher prevalence of concurrent psychosocial health problems, including recreational drug use and early childhood sexual abuse, and argue that little has been done to develop and evaluate interventions that address wider behavioural and lifestyle issues. Alternative approaches, such as sexual health promotion informed by psy-chosexual counselling models while still focusing on the individual, offer a more positive approach, though they do require more time from...

The Ancient Origins of Ageing

The adult, the production of germ cells, sexual activity, and, in many cases, the care of offspring. Obviously, there is enormous variability in the reproductive strategy of various types of animals. Many fish, for example, invest most of their reproductive resources in the production of huge numbers of germ cells, whereas mammals and birds invest less in germ cells and much more in parental care, including the feeding of offspring. The third major investment of resources is in maintenance of the adult body, which, for mammals, was outlined in Chapter 3. The essential point is that the first allocation of resources is essential for all animals, but the second and third are highly variable. We can pinpoint a fundamental principle in saying that there is a trade-off between investment in reproduction and investment in maintenance. So we find animals which grow and reproduce very quickly but have short lifespans, and animals which grow and reproduce slowly with long lifespans. But we...

False Allegations of Sexual Abuse

Ports of sexual abuse to children than are children. The largest proportion of unsubstantiated cases involved insufficient information. Illustrative would be situations in which the child protection caseworker could not locate the family, or the child refused to talk to the caseworker. The next largest proportion were ''legitimate cause for concern, but no sexual abuse.'' In these cases, reporting was appropriate, but some more plausible alternative explanation for the source of concern about abuse was found. An example might be a case in which the source of the child's advanced sexual knowledge was observing adults engaging in sexual activity. This is not to say that false allegations are nonexistent. They do exist, but research to date indicates that true reports are very much more common.

Are there treatments for loss of genital sensation

A loss of sensation in the genital area can pose problems for both men and women with MS. Fortunately, such a loss of sensation in most patients is usually temporary. In men, the use of Viagra and the other drugs in this group can, in part, overcome erectile dysfunction related to decreased sensation in some cases. Temporary or not, for many women, the use of vibrators can overcome the inability to achieve orgasm. Eros is a specially designed commercially available device to enhance clitoral engorgement and provide stimulation for women who require it. It is important that women consult physicians who are knowledgeable in this area. Generally, gynecologists and sex therapists are better informed than most physicians. blood flow to the female sexual organ, the clitoris, is associated with sexual excitement and results in clitoral enlargement (engorgement), and ultimately improves arousal and orgasm (sexual climax) in women. Gynecologists physicians who specialize in diseases that...

Specific Infections Vulvovaginitis

Ampicillin, although less effective, is an alternative drug treatment during pregnancy. Concomitant treatment of the female's sexual partner is still under investigation. The response of patients to metronidazole, although this drug is not effective against any of the nonanaerobic bacteria, supports the role of the anaerobic bacteria in this infection. Furthermore, clindamycin therapy eradicated and or decreased counts of major bacterial vaginosis-associated microflora such as Gardnerella, gram-negative and gram-positive anaerobes, and M. hominis and was correlated with cure in 22 of 24 (92 ) women (17). Possibly the elimination of only the anaerobic component of the infection may help to modify the microbial flora and restore normal condition.

USA UK and Europe

In North America and the UK the first wave of the epidemic occurred in homosexual men. In the UK, proportionally more homosexual men have been notified than in America 67 of cases compared with 48 respectively. Even though infections amongst men who have sex with men still arise, an increasing proportion of new infections in the USA is occurring amongst intravenous drug users sharing needles and equipment. There is also an increase amongst heterosexuals in both the USA and the UK. Currently in the USA, 16 of cases of AIDS have occurred amongst women, and although the commonest risk factor amongst such women is injecting drug use (42 ), the next most common mode of transmission is heterosexual contact (40 ). The nature of the epidemic within the UK is changing with more heterosexual transmission. In the UK 12 of adult cases of AIDS have occurred in women, 70 of which have resulted from heterosexual intercourse. In 2000 there were more new annual infections of HIV than ever before and...

Treatment

Table V Criteria Included in Guidelines for Decision Making about Sexual Abuse 3. Advanced sexual knowledge for the child's developmental 1. Use of inducements to participate in the sexual activity 3. Progression of abuse from less to more intrusive sexual acts 4. Evidence of advanced sexual knowledge

Ethnic Minorities

Various ethnic minorities have different cultural values placed on sex and sexual intercourse. As men tioned earlier, if the culture sees sexual intercourse as procreative and not for pleasure, the presenting complaint may be an inability to conceive rather than lack of pleasure. In cultures where semen is considered highly important and valuable, the individual may well have difficulties with suggestions of masturbation, sen-sate focus activity, and so on, as recommended by the therapist. In some cultures, various sexual taboos may well contribute to the anxiety that the couples experience. Under these circumstances, it would be useful to include this as part of the assessment and to ensure that appropriate therapeutic measures are taken. In some communities, the underlying causation of sexual dysfunction is generally seen as physical rather than psychological, and the patients and their partners may refuse to consider psychological intervention and demand physical treatments only....

Female circumcision

Although illegal in the United Kingdom, female circumcision (also known as female genital mutilation) is still practised within some cultures. This involves deliberate physical damage to the architecture of the vulva of the adolescent or young woman. It is usually carried out by older women within the same culture. The procedure may be carried out with or without anaesthesia however, with anaesthesia the extent of the circumcision can be even more radical. Ill consequences to health include menstrual problems, recurrent urinary tract infections, pain and difficulties having sex, reduced sexual pleasure (from partial or complete removal of the clitoris) and obstructed labour Sensitivity in dealing with this complex issue is vital. Other young women in the same family or social network may be at future risk, and there may be an opportunity for intervention to prevent this.

Child Sexual Abuse

Analogue Studies Research studies, involving staged events (e.g., a visit to a stranger in a trailer) or naturally occurring events (e.g., a medical exam) in children's lives that have some characteristics in common with situations of sexual abuse. Researchers then question children in a variety of ways, some of which may involve attempts to manipulate children or to contaminate their responses, and draw parallels between their responses in these experiments and memory and suggestibility regarding allegations of sexual abuse. Cognitive Distortions Rationalizations (in the case of sexual abuse) of sexual acts that are considered abusive another term used for this phenomenon is ''thinking errors.'' Criminal Sexual Conduct Sexual acts that are crimes, with penalties of incarceration, probation, and parole. These acts either are nonconsensual or involve minors or others unable to give informed consent (de-velopmentally disabled individuals persons under the influence of alcohol or drugs)....

Infections

Hepatitis B and C may result from blood transfusions particularly if they were administered prior to 1991, from an infected sexual partner, or, more rarely, from an infected donor. Importantly, previously infected SCT candidates are at higher risk for GVHD and VOD (Strasser and McDonald, 1999). Overt hepatitis may not manifest itself until after engraftment has occurred and immunosup-pressive agents are tapered. Immunosuppression leads to increases in viral load, and sometimes a significant hepatitis occurs when the immunosuppressive agents are withdrawn. On occasion, a fulminant hepatitis may result. Pre-SCT treatment of hepatitis C is often not feasible because effective therapy with pegylated interferon and rib-avirin usually requires 12 months of therapy. Furthermore, a complication of interferon therapy is bone marrow suppression. Strasser and McDonald (1999) suggested that therapy be attempted once patients are off immunosup-pressive medications for at least 6 months. Infections...

Offender

There is some controversy about offender motivation, for example, some individuals asserting that the offender is motivated by a desire for dominance, not sexual gratification. Sexual abuse, like any sexual act, may fulfill a variety of needs, including the assertion of power, but what differentiates it for other exercises of power is its sexual content. For some offenders (pedophiles), their preferred sexual object is a child, while other offenders experience and act upon sexual arousal to children because of a range of circumstantial factors. These factors include the availability of a child, the absence of an adult sexual partner, and an assault on the offender's self-esteem, such as a divorce or employment loss. Nevertheless, an initial act because of circumstances appears to enhance risk for subsequent sexual abuse to children. The proportion of sexual offenders who prefer children to those who do not is not known, but it is generally assumed that pedophiles are the minority....

Couples Treatment

Ples' relationships attempt to spare the couple and their children from the negative consequences of distress. Like traditional couples therapy, these programs vary theoretically and methodologically, with some programs focusing on teaching communication and problem-solving skills and others promoting awareness of underlying emotional or unconscious factors that might make a couple vulnerable to the development of distress. A review of 85 controlled outcome studies found that the average participant in one of these programs improved more than did 67 of those in corresponding control groups at termination. A recent longitudinal study of a behavior intervention program (PREP) demonstrated that couples who received the intervention had significantly higher relationship satisfaction than the control couples 18 months after the intervention and reported significantly higher sexual satisfaction, less intense marital problems, and higher relationship satisfaction than control couples at the...

Abusive Acts

Sexual abuse involves the full spectrum of sexual activity. These acts are designated and illustrated in Table I. This list of sexual acts progresses from the least intrusive and therefore possibly least traumatic to the most intrusive and possibly most traumatic. However, ism, and lewd and lascivious remarks, in the definition of abusive acts. Activities that do not involve the adult in the sex acts directly, such as prostituting a child or using the child in pornography, are also subsumed under the definition.

Child Victim

Girls and more desirous of sexual activity than girls. Hence boys' sexual experiences during adolescence that otherwise meet the definition of sexual victimization may not be considered abusive by researchers and others. For the relationship to be considered abusive, there usually is an age differential between the victim and the offender, the victim generally being at least 5 years younger than the offender, and 10 years younger when the victim is an adolescent. However, based upon her research of 930 women, Diana Russell pointed out that acts can be abusive without the age differential for example, a brother may be only 3 years older than his sister, but still can impose his will for sexual activity upon her. A gray area is how to handle a situation of what appears to be consensual sexual activity between a teenager and a significantly older person, for example a 14-year-old girl and a 30-year-old man, or a 13-year-old boy and a 25-year-old woman. Professionals who work with boy...

Tropical Ulcers

LGV is caused by one of the serovars (L1, L2 or L3) of Chlamydia trachomatis. The primary skin lesion may well go unnoticed, and is described as a painless papule, pustule or erosion. These organisms are lymphotropic and, in the secondary phase, the main symptoms of LGV are associated with the lymph nodes. The most common sign is tender inguinal and or femoral lym-phadenopathy. Buboes may form and there may be chronic ulceration and fistula formation. Acute haemorrhagic proctitis may also occur. Since 2003 a series of outbreaks of LGV have been reported in European cities (HPA, 2005). These have been among men who have sex with men (MSM), and most cases present with proctitis.

Hiv Risk Assessment

Cal Nurse Specialists to carry out the HIV pre-test discussion. Different criteria may apply regarding referrals to these professionals these often depend on patients' risk behaviour and ethnicity. Patients who may be referred include men who have sex with men, intravenous drug users, and people from sub-Saharan Africa or the Caribbean, in addition to people who have sex with people from these groups. In some clinics the person taking the sexual history and assessing symptoms will do the pre-test counselling, and these people tend to be the Nurse Practitioners, Doctors, Health Practitioners or Health Advisers. All these groups should receive training and support about how to conduct appropriate pre- and post-test discussions.

Informal Approaches

Theories of epidemic transmission offer qualitative insight into the shape of the infection curve and thus provide a check on the plausibility of back-calculated infection rates. For example, one reconstruction of the U.S. infection curve based on back-calculation with splines (Figure 8.11) showed that the epidemic quickly slowed to subexponential growth by the early 1980s. The doubling times of the epidemic (time for cumulative numbers infected to double) increased from 7.8 months in the beginning of 1981 to 12.7 months in the beginning of 1982 to 19.2 months in the beginning of 1983. According to epidemic theory this rapid increase in doubling times could result initially from diffusion of the epidemic from high to lower risk subgroups e.g., subgroups with fewer number of sexual partners) and, later, from favorable behavioral changes and also saturation effects (depletion of uninfected individuals). Infection rates among intravenous drug users grew more rapidly before 1981 than...

Confidentiality

Having considered the duty of confidentiality and its importance and rigidity, when may there be a circumstance when the need for confidentiality can be challenged Perhaps in a climate where knowingly passing on the HIV virus has become a criminal act (R v Adaye (2004), R v Dica (2003), R v Konzani (2004)), this absolute view of the confidential nurse-patient relationship must be brought into question. As a nurse engaging patients in the process of testing for HIV, what should one do when the scenario arises where you, the healthcare professional, are fully aware of a client's HIV diagnosis and also have the knowledge that they are having unprotected sex with their regular partner. To some, this scenario may sound extreme and far-fetched yet to many who work in sexual health clinics it is a situation that seems to arise with greater and greater frequency. The recent emergence of successful prosecutions for knowingly passing on the HIV virus is considered a worrying trend in some...

Motivational life

After a few minutes your flat-mate starts giggling and then snorts with laughter. He points out that you have consistently used the word 'orgasm' when you clearly meant to use the word 'organism'. Why might you have done this How could you have done that Clearly, you know both words and the difference between them, so what happened did so unconsciously.

Sex and death

One of the most important points about sex is that it allows more complex organisms to flourish it increases the redundancy of the genome and thereby stabilises it. The more complex the organism, the bigger the genome. The bigger the genome, the higher the risk of fatal damage to the DNA between one generation and the next. The faster the accumulation of DNA damage, the faster the extinction of the species. It is because sex insures against mutational damage that it allows complex organisms to survive. There is a theoretical limit, beyond which any further increase of complexity would over-stretch the DNA repair machinery, but perhaps only organisms as complex as ourselves approach that limit.

Prognosis

Prognosis of sexual dysfunction varies according to the type of dysfunction. The literature on sex therapy indicates that prognosis in general depends on a number of factors. One is the motivation of the patient couple. A good overall relationship is also associated with a good outcome. Concurrent psychiatric disorder is a hindrance to good progress. While the different disorders have varying degrees of success, the prog nosis for vaginismus is probably the most positive. In female orgasmic dysfunction, it appears that younger patients do better in treatment.

Anorectal Disease

A variety of classic venereal diseases can produce anorectal ulcerations. Diagnosis and treatment of Neisseria gonorrhoea proctitis is similar in AIDS and non-AIDS patients. Syphilis may have an atypical presentation in HIV-infected subjects, and serologic diagnosis is affected by the presence of immune deficiency. Chlamydia is prevalent in sexually active groups. The frequency of chancroid, caused by Haemophilus ducreyi, in HIV-infected patients is unknown. Rectal spirochetosis has been recognized in homosexual men with or without HIV infection (Nielsen et al, 1983). The infection usually is asymptomatic and an incidental finding on examination.

Resolution

Tented Vagina

During resolution the uterus drops forward to its resting position. The orgasmic platform quickly relaxes, while the inner end of the vagina returns more slowly to its normal Uterus is tented (vertical) and cervix is withdrawn from vagina orgasmic platform (lower one-third) of vagina constricts penis clitoris is engorged and its glans is withdrawn beneath prepuce labia bright red or violet 4. Orgasm Orgasmic platform contracts rhythmically cervix may dip into pool of semen uterus exhibits peristaltic contractions anal and urinary sphincters constrict Uterus returns to original position orgasmic platform relaxes inner end of vagina constricts and returns to original dimensions dimensions. The flush disappears quickly and the areolae and nipples undergo rapid detumescence, but it may take 5 to 10 minutes for the breasts to return to their normal size. In many women (and men) there is a postorgasmic outbreak of perspiration. Unlike men, women do not have a refractory period and may...

The epididymis

Cross Section The Epididymis

The epididymis can be divided into three sections. This may be done on the basis of anatomy that is, on epithelial cell characteristics - namely, the caput or head, the corpus or body, and the caudal or tail end of the epididymis or alternatively, on the basis of function - namely, the initial (part of the efferent ducts plus the initial part of the caput), the middle (remainder of the caput plus the corpus) and the terminal (cauda plus the proximal vas deferens). The caudal end of the epididymis lies caudal to the testis, forming the characteristic projection seen on the exterior of the scrotum when viewed in the live animal. It is this caudal end that joins with the vas deferens and, as the terminal section, it is the major site of spermatozoan storage, providing storage for between 53 and 62 of the extra-gonadal spermatozoa reserves in sexually active and rested stallions, respectively (Gebauer et al., 1974a Amann et al., 1979a). The middle epididymis is responsible primarily for...

The Urethra

External Urethral Orifice

The urethra conveys urine out of the body. In the female, it is a tube 3 to 4 cm long bound to the anterior wall of the vagina by connective tissue. Its opening, the external ure-thral orifice, lies between the vaginal orifice and clitoris. The male urethra is about 18 cm long and has three regions (1) The prostatic urethra begins at the urinary bladder and passes for about 2.5 cm through the prostate gland. During orgasm, it receives semen from the reproductive glands. (2) The membranous urethra is a short (0.5 cm), thin-walled portion where the urethra passes through the muscular floor of the pelvic cavity. (3) The spongy (penile) urethra is about 15 cm long and passes through the penis to the external urethral orifice. It is named for the corpus spongiosum of the penis, through which it passes. The male urethra assumes an S shape it passes downward from the bladder, turns anteriorly as it enters the root of the penis, and then turns about 90 downward again as it enters the...

Origins

My father's infatuation with my mother was short-lived. I never knew my parents other than as a bitter, loveless couple, who rarely spoke to each other. They still had sex (early Sunday mornings, I think), but that was their only communication. My father was away on business trips quite often and life at home After I left home at age 17, I began to have normal opportunities for female companionship, but for many years I retained severe fears and inhibitions. My sex life was substandard, even by old-fashioned criteria, until well into my twenties.

Testicular hormones

Testosterone Stallions

Concentrations were significantly higher at 6.00 hours and 18.00 hours, the average increase being 100 (Pickett et al., 1989). Sexual activity shows a similar diurnal variation and it may be postulated that, in the wild, mating activity is increased at dusk and dawn, as at these times the horse is at least risk from predators. Testosterone levels are also reported to vary with testis size and to increase with age. It has been postulated that this may account for the variation in spermatozoan production evident between stallions within a single breeding season (Berndtson and Jones, 1989). Oxytocin is a neuropeptide, synthesized as part of a larger molecule, neuro-physin (OT-NP) (Nett, 1993). Oxytocin is known to be produced by the Leidig cells of the testis of the ram and the rat and to pass into the interstitial fluid (Knickerbocker et al., 1988 Pickering et al., 1989). From here it passes to the Sertoli cells and on to the lumen of the seminiferous tubules it seems that it may also...

Groin And Pubic Area

Ideally the penis should be examined prior to the client voiding urine, as this will reveal any apparent discharge. At this point the nurse can observe the penis for any abnormal curvature, such as those seen in Peyronie's Disease (Swartz, 2002). This is where internal scarring of the corpora cavernosa causes the penis to bend sharply up, down or to the side. Men with Peyronie's may experience pain during sexual intercourse, and, if the condition persists, they may eventually notice shortening of the penis, both of which can be distressing for the patients (Gholami and Lue, 2001). The exact cause of Peyronie's disease is uncertain, but it is probably caused by minor trauma to the penis, which leads to hardening of the tissue (fibrosis) of the tunica albuginea layer that surrounds the corpora cavernosa. The penis will bend in the direction of the fibrous scar tissue, so that if there is hardening on the right side of the penis then the penis will bend sharply right. Usually if the...

Investigations

Sexual dysfunction is a frequent and early symptom of MSA, particularly in male patients. Since male MSA patients frequently develop erectile failure in their forties, and therefore experience substantial impairment of their sexual performance, expert uroneurological advice should be sought for further investigation and implementation of appropriate therapeutic intervention. The pathophysiology of impotence in MSA is unclear however, it is likely to include central autonomic disturbance and, more rarely, peripheral factors such as venous leakage.

Rectal pain

Incontinence can occur in the presence of a normal sphincter if there is severe diarrhoea. Consultation is needed to assess recent travel abroad, recent diet or change in sexual partner and current sexual practices. The clinician should obtain a stool sample for microscopy and culture. Blood tests for Hepatitis A, B, and C should he undertaken (BASHH, 2005a), but these tests usually do not have an early detection rate, so there should be referral to a senior doctor or an infectious diseases unit if there are other hepatic symptoms and or hepatitis is suspected. Usually, however, diarrhoea is due to poor sphincter Patients may complain of severe pain during defecation, sometimes associated with bright red rectal bleeding. Fissures can be easily diagnosed by examination however, all fissures in men who have sex with men should be screened for LGV, dark ground microscopy on three samples is recommended and syphilis serology.

The Medical Papyri

The Kahun papyrus, which was probably composed about 1900 b.c.e., consists of fragments dealing with gynecology and veterinary medicine, including methods for detecting pregnancy, predicting the sex of the fetus, and preventing conception. One of the contraceptives was basically a pessary (vaginal suppository) containing crocodile dung. Other prescriptions call for a plug (rather like a contraceptive sponge) made with honey and natron, an extract of the acacia plant, and a gum-like material. Later contraceptive prescriptions kept the spirit of the Egyptian recipe, but substituted elephant dung for that of the crocodile. Greek observers noted that the Egyptians seemed to regulate the size of their families without infanticide. This suggests that even the most noxious and bizarre pessaries might work if they functioned as mechanical barriers, or spermicides, or caused a total lack of interest in sexual intercourse. Prolonged lactation, which tends to suppress ovulation, and a three-year...

Bacterial vaginosis

Bacterial vaginosis can be indicated if there is a grey white thin, homogeneous discharge with a pungent, unpleasant 'fishy' odour. There may be a minimal amount of discharge coating the vaginal walls or copious amounts, which may be present on the vulva prior to examination or pour into the speculum on insertion. BV is not usually associated with vaginitis however, there may be some physical irritation (such as itching) from the presence of the discharge. The discharge and associated odour can be particularly unpleasant and impact on self-esteem and relationships. The aetiology of BV is uncertain, but it is not considered to be a sexually transmitted infection, and there is little no benefit in treating sexual partners. Over-zealous hygiene (including more than daily washing and washing inside the vagina), bathing in antiseptic solutions, bubble baths and washing the genital area with perfumed soaps and shower gels appear to exacerbate the problem. The infection is associated with an...

Prevention Efforts

Several steps have been taken to prevent HIV transmission through the blood supply. In 1983, the U.S. Public Health Service first recommended that members of high risk groups be urged not to give blood. In the spring of 1985, compulsory ELISA screening of donated blood and blood products for HIV began. If the initial test was positive, the blood was not to be transfused or manufactured into other products capable of transmitting infectious agents (CDC, 1985a). This procedure maximizes sensitivity for detecting contaminated blood. To improve specificity for counselling donors, the test is only regarded as positive if the ELISA assay is repeatedly positive and if a subsequent positive WB result is obtained. Persons found to be positive are urged not to donate again. It is common practice for a blood bank to retain a confidential list of persons previously tested positive at that facility, and to use that list to prevent subsequent donations by such persons. Since the spring of 1985, the...

Questioning Styles

There is debate about the use of colloquial language, mirroring the language of the client. The interview is an opportunity for education as well as problemsolving, and the author believes that as a professional you need to assist the interviewee to tell you their story. 'When you say screwing her, do you mean your penis in her vagina ' The use of this style may assist the person in future visits with your service, as they may pick up the terms you have used to describe how they have sex with their partner (Clutterbuck, 2004 Green, 1999 Law & McCoriston, 1996). If you have not had the opportunity to learn about sexual practices before, familiarise yourself now with all the things people can do in enjoying a full sex life, as well as the language that is used to describe each of them. Here are a few examples

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