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...

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Introduction to virus transmission

On their journeys between hosts viruses may have to survive adverse conditions in an environment such as air, water or soil the survival of virus infectivity outside the host is discussed in Chapter 23. There are some viruses, however, that can be transmitted to new hosts without 'seeing the light of day', in other words without exposure to the outside environment. These are viruses that can be transmitted directly from host to host, for example during kissing or sexual intercourse, and viruses that are transmitted via vectors. Also included in this category are viruses that can be

Hormonal fluctuations

An interview survey of 124 perimenopausal women found that the age group centering around 49 years did not have sexual difficulties in desire, response, or satisfaction in their sexual life, whereas a subset of women with very low estradiol levels tended to have reduced coital activity.19 In a study of 43 perimenopausal women who kept daily records of menstrual cycles and sexual activity, a negative association was found between hot flush ratings and regularity of sexual intercourse at both time points. Frequency of sexual intercourse and level of plasma estradiol were higher, and hot flush ratings were lower in early perimenopausal women who were still having cycles at least once every 30 days, as compared with late perimenopausal women who were cycling less often. A close association exists between increasing irregularity of menstrual cycles, hot flushes, declining estradiol levels, and declining frequency of intercourse during the perimenopause.20 Alongitudinal study of 39 women,...

Management of sexual concerns Decreased sexual desire

Sexual desire is that which causes one to be receptive to or initiate sexual activity. For women, the quality of the relationship and the emotional and physical satisfaction she receives from that relationship appear to be critical elements. Desire requires androgens such as testosterone and DHEAs, neurotransmitters, and the sensory system. Starting in the twenties, there is a progressive decline of physiologically available androgens for both men and women, which can contribute to decreased sexual interest. Interest in sexual activity can be disrupted by psychosocial, physiological, physical, environmental, and cultural factors. Fatigue, depression, side effects from medications, self-esteem, and body image concerns can all interfere with sexual interest. Addressing relationship issues through counseling, supplementing androgens, treating depression, and assessing medication side effects are all important. More important for good sexual desire is attending to scheduling the time and...

Longterm relationships

Lack of spontaneity, routine, and attention to matters other then sexual relationships can add particular challenges to long-term relationships. The earlier erotic nature of the newness of the relationship becomes replaced by a predictable and less prioritorized sexual exchange. Responsibilities of paying bills, concerns about health, and caringfor children, grandchildren, or agingparents can take priority over the time the couple has to spend with each other. Quality of life, satisfaction with the relationship, and longevity are associated positively with sexual activity within a committed relationship 7 Couples should be encouraged to regard their sexual life a priority scheduling time and privacy for themselves separate from other life responsibilities is essential. Encourage couples to maintain erotic levels through seduction, touch, and massage outside of and in addition to sexual exchange, use of sensuality such as pleasing scents, music, and lubricants to enhance sexual...

Sexual pain syndromes

Pain during sexual activity can vary from pain with initiation of intercourse to deep dyspareunia (Table 5.8). Sexual pain syndromes are associated with a history of abuse. Clinicians should screen for this history and provide suggestions for individual and couple therapy to support the woman as she tries to reconcile her past. the sensation of PC muscle relaxation after the squeeze. Recommending the use of mirrors to become comfortable looking at and touching her external genitalia can help her to become more comfortable with her body. Becoming Orgasmic36 is an excellent reference it includes illustrations of variation in the appearance of women's external genital anatomy. The next step is to incorporate her partner. This can be uncomfortable for both parties, but it can also initiate a lot of intimate discussion about sexuality and sexual activity between partners. The woman's partner should give her total control over these steps. Initially, she and her partner should simply look...

From Higher Centers

THE HYPOTHALAMIC-NEUROHYPOPHYSEAL SYSTEM (HNHS). The hypothalamus (HT), via neural connections, stimulates the secretion of oxytocin and vassopressin (or ADH) from the posterior pituitary (PP), also called neurohypophy-sis. Mechanical receptors R located in the genitalia, uterus, and in the breasts stimulate hypothalamic detectors to elicit contractions in the smooth musculature of these organs to favor sperm transport during sexual intercourse, birth delivery and milk secretion during nursing. ADH, in turn, has an effect on the extracellular fluid osmolality that is constantly checked by other hypothalamic receptors, thus, establishing a negative feedback loop. Figure 2.65. THE HYPOTHALAMIC-NEUROHYPOPHYSEAL SYSTEM (HNHS). The hypothalamus (HT), via neural connections, stimulates the secretion of oxytocin and vassopressin (or ADH) from the posterior pituitary (PP), also called neurohypophy-sis. Mechanical receptors R located in the genitalia, uterus, and in the breasts...

What causes stress in diabetes

Diabetes can cause stress in a number of different ways. You may feel under a great deal of pressure to maintain 'perfect' control of your diabetes. You may feel stressed because the side-effects of diabetes are interfering with your sex life and relationships. Problems with your treatment or adjustments to dietary and lifestyle changes can cause stress. Fears of short- or long-term complications are also common stressors for people with diabetes, and indeed worries about being able to fulfil responsibilities may also provoke a stress response.

New Perspectives On Progesterone Action In The Uterus

The comparative effect of sexual experience on male sexual behavior in the WT and PRKO. (A) Mount frequencies of experienced (EXP) and na ve (NA VE) WT and PRKO males castrated for 3 wk. (B) Intromission frequencies in 3-wk castrates. Numbers in parentheses refer to sample sizes. Reproduced with permission of Phelps et al. (107). Fig. 7. The comparative effect of sexual experience on male sexual behavior in the WT and PRKO. (A) Mount frequencies of experienced (EXP) and na ve (NA VE) WT and PRKO males castrated for 3 wk. (B) Intromission frequencies in 3-wk castrates. Numbers in parentheses refer to sample sizes. Reproduced with permission of Phelps et al. (107).

Prevention And Control

Where Ro (the reproductive rate) is greater than 1, the disease will increase in prevalence in the community. The reproductive rate is dependent on the efficiency of transmission (B), the rate of sexual partner change (c), and the duration of infec-tiveness (D). Attempts to reduce the reproductive rate can be directed at interventions that may alter these factors. identifying high-risk groups for targeted interventions, screening high-risk asymptomatic patients for infection, identifying and treating sexual partners of patients with gonorrhea, and rescreening those identified with infection 3 to 4 months after treatment.136

Overwhelming Postsplenectomy Sepsis

One month ago he was hospitalized with severe febrile proctocolitis that was diagnosed as lymphogranuloma venereum. He has also been treated several times in the past for amebiasis and shigella colitis and admits to having receptive anal intercourse. Further history reveals that his most recent sexual partner has been suffering from urethral pain and discharge.

Comparative Cost Analysis

The treatment of fibroids involves a range of medical and non-medical resources. The cost of treatment is measured in terms of opportunity cost in other words, the consumption of other goods and services that society gives up in providing care (Dranove 1996). These costs fall into two general categories direct and indirect. Direct costs are defined as the value of all the resources consumed in providing treatment and dealing with the medical consequences of treatment indefinitely into the future (Luce, 1996). In the case of UAE, medical costs include the value of the consumables used during the procedure (angiography catheters, PVA material), physician and non-physician time, and marginal cost of equipment (wear and tear, opportunity cost if equipment is in full use currently). Indirect costs or productivity costs are defined as the value of work and leisure lost due to death or functional impairment as a result of treatment, as well as the cost of care provided to the patient by...

Things That Change Dreams For Individuals

After he becomes aware that he initiated a pregnancy in a woman, the prospective father recalls dreaming more about his sexual masculinity and identity. He may recall dreams with more sexual activity in them. A conflict between his machismo and his nurturance may also emerge. During the middle of the pregnancy, the themes of nurturance continue, but dreams about his general identity replace those of overt sex. In his dreams, he may compare himself to his father and to his family when he was a child. At the same time he may dream of being left out of the pregnancy process, or he may even dream about being pregnant himself He often will dream about his relationship with his pregnant partner. Later in the pregnancy, his recalled dreams about his childhood family diminish, being replaced by content about his current family. He may also recall dreaming about his changes in his partner's body, what his child will be like (more often as a son than a daughter), and, toward the end of the...

Testicular Prostheses

The most troublesome complication is infection, which often necessitates removal of the prosthesis. In the long term, satisfaction with testicular prostheses is variable. Encapsulation resulting in hardening can occur with time, resulting in a less natural texture. In one series 27 of men were dissatisfied and felt that they had an average or poor cosmetic result 4 . In another series, 20 of patients felt uncomfortable in sexual encounters and only 58 were happy with their sex life 5 . Patients therefore should be counseled appropriately preopera-tively and many will opt simply to have an orchidectomy without prosthesis.

Summary And Conclusions

Reports of UAE in the lay press have generated considerable enthusiasm, suggesting that demand for a non-surgical (albeit still invasive) treatment of myomata would be high (Gilbert,1999). The prevalence of symptomatic fibroids, the apparent high demand for a new treatment, and the rough equivalence of outcomes among UAE, hysterectomy, and myomectomy suggest that controlled trials of these treatments would be feasible, ethical, and desirable. The expert panel concluded that beginning a properly designed randomized, controlled trial would be crucial in establishing the comparative risks and benefits of UAE, hysterectomy, and myomectomy. The panel further believed that the validity of such a trial would be enhanced by careful measurement of several short and long term outcomes. Key short term outcomes which the panel agreed should be included were death, reoperation (e.g. hysterectomy for infection following UAE), and operative injury. Long term outcomes similarly identified included...

Methods Of Contraception

Abstinence, in this sense, means that one refrains from engaging in sexual intercourse. Theoretically, this means that abstinence is 100 percent effective in preventing pregnancy. However, intercourse does not have to occur in order for fertilization of the egg to occur. If sperm are deposited in one way or another in or around the vagina, it is possible that sperm could move themselves up the vaginal canal and eventually fertilize the egg. e. Prophylactic (Condom) Method. In this method, a condom is used to cover the penis in order that ejaculated sperm cannot enter the vagina. Hence, this method is a mechanical block against pregnancy. This method also serves to reduce the chances of contracting of venereal disease from the sexual partner. In terms of effectiveness of pregnancy prevention, approximately 10 of 100 couples who use this method find the female becomes pregnant. The advantage of this method is that no chemicals are used and the method is convenient. The...

Infections of the Genital Tract in

Chlamydial infection of the urethra results in the development of NGU. C. trachomatis is the causative agent in approximately 50 of cases of NGU, while other possible causes include Mycoplasma genitalium and Ureaplasma ure-alyticum. Clinically, chlamydia-positive and chlamydia-negative NGU cannot be differentiated on the basis of signs or symptoms. The incubation period of NGU (including chlamydial urethritis) is longer than that of gonorrhoea, varying from 1 to 3 weeks in the majority of cases, and the onset of symptoms of NGU is more insidious. These symptoms include dysuria, appearance of a clear or white urethral discharge, and occasionally frequency of micturition. Many patients may be asymptomatic or minimally symptomatic, which results in prolonged periods when they may be infectious to their sexual partner. Despite these mild manifestations, it is often difficult to differentiate between gonococcal and chlamydial infections on clinical grounds alone and, indeed, the two...

Lymphogranuloma Venereum

The disease has a worldwide distribution, but is most prevalent in tropical and subtropical countries. The rapid growth of international travel has also resulted in an increasing number of cases being reported from Europe, and many cases were imported into the United States by servicemen returning from Southeast Asia in the 1970s. More recently, outbreaks of LGV proctocolitis have been documented among men who have sex with men (MSM) in European countries that traditionally had few reports of disease.34

Is it dangerous to take oral contraceptives

If for whatever reason your family planning method was not used properly before sex, you can still avoid becoming pregnant by taking a larger-than-usual amount of some kinds of birth control pills, or special pills made for this purpose, soon after having sex. See page 395.

Vulvodynia and mucosal disorders

Vulvodynia is a pain syndrome characterized by painful burning sensations, allody-nia, hyperalgesia and itching, usually localized in the region of the vulvar vestibules 72 . Vulvar tissue arises from the same urogenital progenitors as bladder hence it might not be surprising to find parallels involving hyperproliferation of nociceptive fibers. In vulvodynia patients, the hypersensitivity of vulvar C-fibers is well documented 73, 74 , and immunohistological evaluation of small-diameter nociceptive nerve fibers shows increased densities relative to normal subjects 22, 26 . Moreover, TRPV1 expression appears to be significantly increased in these proliferated nociceptors 75 . Low-concentration topical capsaicin has been evaluated as a treatment for vulvar vestibulitis, the most common form of vulvodynia. Following 12 weeks of daily applications, significant improvements in pain, irritation and ability to engage in sexual intercourse were reported 76 .

Other Methods Of Family Planning

Condom' should be put on when the man's penis is hard but before it touches the woman's genitals. After he ejaculates (comes), the man should hold the condom and withdraw from the woman's vagina while the penis is still hard. Then take off the condom without spilling the sperm, tie it shut, and discard it. A couple should use a new condom every time they have sex. Keep condoms in a cool, dry place away from sunlight. Condoms from old or torn packages are more likely to break. THE CONDOM FOR WOMEN is a thin, plastic sheath that fits inside the vagina. A flexible ring at the closed end of the condom holds it in place. The other ring at the open end hangs out, covering the outer lips of the vagina. This condom can be put in any time before sex and should be taken out immediately after sex. It should be used only once, because it may break if it is washed and reused. But reusing a female condom is better than no condom. The female condom is the most effective method controlled by women...

Home Methods For Preventing Pregnancy

Every community has traditional methods to prevent or stop pregnancy. Some of these can help limit the number of children a couple has, but they are usually not as effective as modern methods. Some traditional methods can be harmful, and some do not work at all. For example, washing out the vagina or urinating after sex will not prevent pregnancy. Push the wet sponge deep into your vagina before having sex. You can put it in up to 1 hour before. Leave the sponge in at least 6 hours after having sex. Then take it out. If you have trouble getting it out, next time tie a ribbon or piece of string to it that you can pull.

Somatoform Pain Disorder

Exam reveals that she has been unable to participate in sexual intercourse because of severe vaginal contractions elicited by attempts at penile penetration of the vagina. these symptoms many times in the past with various sexual partners. She has been dating her current partner for 4 months and lias become progressively anxious with respect to their heightened sexual activity she wishes to have intercourse with him yet fears a repetition of past failures. She also reports difficulty in inserting tampons.

C Sexual Abuse of a Child

Any sexual activity between an adult and a child (child a person under the age of 18) is defined as sexual abuse. Types of sexual abuse of a child include rape (rape of a child, formerly called statutory rape, sexual intercourse with a girl, not the offender's wife, under the age of consent), incest, indecent assault, child pornography, and child prostitution. Included are child molestation (fondling or masturbation of the child by another person), intercourse (vaginal, anal, or oral intercourse even though not forced on the child), and family-related rape. Usually, the child victim is a girl (in 90 percent of the cases), and half of these child victims are under the age of 12. The person committing the abuse is male 99 percent of the time. (c) The offender may place blame on the victim. Many adults blame the child for not resisting the abuser. Remember, children are taught early in life to obey adults and to do as adults tell them. Particularly among children under...

Fungal Infections Candidiasis

Labia Majora Crease

The majority of vulvovaginal yeast is produced by Candida albicans, but an increasingly large proportion of yeast infections involve Candida glabrata, Candida tropicalis, Candida parapsilosis, Candida krusei, Candida lusitaniae, Saccharomyces cerevisiae, or even less common organisms (44). Because the colon is a natural reservoir for yeast, occluded, moist, warm anogenital skin provides an ideal environment for infection, particularly in the setting of risk factors such as use of antibiotics, vigorous sexual activity, diabetes, incontinence, immunosuppression, and obesity. Some patients experienced frequently recurrent vulvovaginal candidiasis. These patients can generally be managed with fluconazole 150 mg weekly (49), although a very rare patient requires every fourth day dosing. Medication is continued for three to six months. In some women, the fluconazole has broken this cycle and can be discontinued. Other patients require a longer course. Hepatotoxicity is not a major concern...

Xylocaine Infiltration For Marsupialization

Marsupialization For Pulmonary

Stage Ib cervical cancer is diagnosed in a young woman who wishes to retain her ability to have sexual intercourse. Your consultant has therefore recommended a radical hysterectomy. Assuming that the cancer is confined to the cervix and that intraoperative biopsies are negative, which of the following structures would not be removed during the radical hysterectomy A 20-year-old G3P0030 obese female comes to your office for a routine gynecologic exam. She is single, but is currently sexually active. She has a history of five sexual partners in the past, and became sexually active at age 15. She has had three first-trimester voluntary pregnancy terminations. She uses Depo-Provera for birth control, and reports occasionally using condoms as well. She was treated for chlamydia last year, but denies any prior history of abnormal Pap smears. The patient denies use of any illicit drugs, but admits to smoking about one pack of cigarettes a day. Her physical exam is normal. However, 3...

Obstetrics and Gynecology

A 23-year-old woman presents with fever and bilateral lower quadrant abdominal pain for two days. She complains of the onset of a mucopurulent vaginal discharge with her menses, which she states is yellowish in color. She has a new sexual partner and uses a nonbar-rier method of contraception. Her temperature is 103.2 F She has bilateral lower quadrant tenderness with palpation, and pelvic examination reveals cervical and adnexal motion tenderness. A mass is palpable in the left adnexa. Which of the following is the most likely diagnosis

Social Phobia F401 30023

For fear of shaking, blushing, sweating or looking ridiculous, some people will not face another passenger in a bus or train or walk past a queue of people. They are terrified of attracting attention by seeming awkward or fainting. Some may leave their house only under cover of darkness or fog. They will avoid talking to superiors and stage fright prevents them performing to an audience. They stop swimming to avoid strangers looking at their bodies. They shun parties and are too embarrassed to talk to others. ''I can't have normal conversation with people. I break out in a sweat, that's my whole problem even with the missus,'' said a man, who still continued normal sex with her. The fear may appear only in the presence of the opposite sex, or manifest equally in front of men and women. Lack of self-assertion is common even in otherwise well-adjusted people. It may stop them accepting promotion at work and restrict their lives e.g. a man's shyness since childhood worsened when at 18 he...

Ovarian Steroid Secretion Data

At baseline, all subjects were interviewed regarding their menstrual history, pregnancies, past and present contraceptive use, sexual activity, use of cigarettes and alcohol. During the baseline study cycle, all women underwent a complete physical examination including height and weight measurement. Blood and urine specimens were collected during all study menstrual cycles.

Items 415 through 416

A 28-year-old patient, GoPoAo, comes for her first prenatal visit at 6 wk of pregnancy. Her examination is normal for gesta-tional age. Her history reveals that she does not smoke. She drinks one glass of wine about 2 days a week. She has been married for 3 years and her husband is her only sexual partner. She is employed as a paralegal. Her family history is negative. She is very concerned about preserving the mental and physical health of her baby. Which of the following interventions is most likely to reduce the risk of neurological defect in the infant

Psychological aspects of menopause Menopause as a transition

Most of the uncertainty women expressed about menopause related to their ownexpectations of menopause itself. Finally, the North American Menopause Society survey found that the majority of women viewed menopause and mid life as the beginning of positive life and health changes. More than 75 of women surveyed reported making health-related lifestyle changes, such as smoking cessation, at menopause. Hysterectomy was also a factor associated with improved spouse partner relationships, improved sexual relationships, improved physical health, and sense of personal fulfillment.23 The changes in female sexuality with the menopause have been examined poorly. While sexual problems are common in women attending menopause or gynecology clinics, the picture is less clear in the general population.39 With increasing age, levels of sexual desire as well as frequency of sexual activity and orgasm decrease.39 However, the extent to which menopause contributes to these changes is unclear. Decline in...

Is Livergen Suitable For Three Months Pregnancies

The answer is a. (Braunwald, 15 e, p 48.) The current recommendation for workup of abnormal cervical cytology includes repeat Pap smear at 3 to 4 months, HPV DNA typing, or colposcopy, depending on the patient and her history. A Pap smear every 3 years is acceptable for low-risk patients with three negative annual consecutive Pap smears. There is no recommendation for early repeat Pap smear if a patient has a new sexual partner. Sexually active women should have annual cervical screening, with the exception of low-risk patients, who can discuss changing the screening interval with their physician.

Augmentation Cystoplasty With Without Continent Catheterizable Abdominal Stoma And Continent Urinary Diversion

These procedures are far preferable to either urinary conduit diversions or an indwelling vesical catheter for both medical and psychosocial reasons. From a psychosocial viewpoint, a continent abdominal stoma relieves the patient of the burden of an external urinary drainage bag. From a medical standpoint, the creation of a large capacity, low-pressure internal urinary reservoir greatly reduces the chances of urosepsis, urolithiasis, hydronephrosis, and ultimately, renal failure. Further, these procedures result in improved self-image and sexual experiences (81).

State Trait Anger Expression Inventory2

A review of the literature in this area will generally find that sexual concerns have been neglected in much of the posttraumatic head injury and rehabilitation literature. Authors do report that the sexual sequelae after head injury include impulsiveness, inappropriateness, change in sex drive, reduction in sexual frequency, global sexual difficulties, and specific sexual dysfunctions.39 Over 50 of individuals who suffer traumatic brain injury are reported to demonstrate a decrease in sexual arousal postinjury. Crowe and Ponsford40 studied this in males and determined that men following brain injury have difficulty developing sexual imagery. Their results indicate that sexual arousal disturbances may exist above and beyond the disturbances of affect that have been associated with frontal injury from trauma. Interestingly, other researchers41 have found that patients with frontal lobe lesions following brain injury reported an overall higher level of sexual satisfaction and...

Erectile Function

Surgical factors that adversely influence early return of sexual activity include perioperative traction or ischemic injury to the cavernous nerves within the posterolateral neurovascular bundles. Visualization and preservation of these nerves during radical prostatectomy may be difficult or imprecise. Their course is indicated by the posterolateral vascular bundles as they are dissected from the prostatic fascia, but the nerves themselves are

Aging children

The reverse phenomenon - the return of the adult child to the home - may be a more stressful and difficult adaptation for mid-life women. Known in popular culture as boomerang kids,44 there is a trend of higher numbers of children aged 25-34 living at home, though data are limited and more likely to be reported in popular lay literature than studied. Predictors of a child returning home after leaving previously are change in marital status such as divorce, pursuing further educational opportunities, financial constraints, and initial reason for leaving home.45 Though the stressors inherent in adapting to the returned presence of an adult child seem obvious, in the Australian study the only negative finding was a trend toward reduced frequency in sexual activity no mood changes were found.42 The individual circumstances of the

Importance

Sexuality is much more then sexual behavior. Sexuality is an important part of one's health, quality of life, and general wellbeing. Sexuality is an integral part of the total person, affecting the way each individual - from birth to death - relates to herself, her sexual partner(s), and every other person.1 This time of life can and should be a tremendously positive time for women in regards to sexual health. How a woman successfully navigates sexual health risks depends on the complexity of how she defines herself and her sexuality in relationship to aging, menstruation, childbearing capability, success with overcoming challenges of her past, and the quality of intimate partnership(s). Risks to sexual health can include unplanned pregnancy, the physiologic changes of transition into and through menopause and with aging, the increased probability of chronic illness and its medical and surgical treatment, abuse in any form, and sexually transmitted infections. Unable to orgasm

Epidemiology

For genders, for same-sex, and opposite-sex couples, the value of and participation in sexual activity within a relationship appears relatively stable with increasing age. Whatever the individual's and couple's interest and level of activity early on in the relationship, it continues relatively stable with increasing age. Women's sexual concerns change with age. A primary care patient-based survey of approximately 1200 women revealed that women aged 55 years and older were significantly less likely than younger women to be concerned about body image and having painful intercourse. They were more likely to report concerns about their partner having sexual difficulties and report that they never had orgasm when compared with women between ages 45 and 54, and even more so compared with women under age 45.3 In this same study, approximately 60 of women younger than age 45 (63 , n 629) and aged 45-54 (66 , n 169) reported having sexual desires that differed from their partners. For women,...

Psychosocial issues

The Massachusetts Women's Health Study II was a study of 200 women transitioning through the menopause who were not hormone replacement therapy (HRT) users, who had not had a surgical menopause, and who had partners. It examined associations among menopause status, various aspects of sexual functioning, and the relative contributions of menopause status and other variables to various aspects of sexual functioning. The women were classified as pre-, peri-, or postmenopausal, according to menstrual cycle characteristics and measures of estradiol, estrone, and follicle-stimulating hormone. Menopause status was related significantly to lower sexual desire, a belief that interest in sexual activity declines with age, and women's reports of decreased arousal compared with when in their forties. However, factors such as health, marital status (or new partner), mental health, and smoking had a greater impact than menopause status on women's sexual functioning .13

Body image

How a woman defines her sexuality in relationship to her uterus and ovaries, menstrual cycle, and or fertility status can affect the intensity ofher griefreac-tion, to menopause body image, and self-esteem. How she adapts to wrinkles and other visible changes of age - such as reframing age spots as experience spots - can determine how she transitions through ego integrity versus despair. biology that warrants the prevalent image of sexless, neutered, loveless aging. For many aging people, sexual desire, physical love, and sexual activity continue to be integral parts of their lives, and intimacy is expressed, in addition to intercourse, through closeness, touching, and body warmth. In essence, caring and gentleness in loving activities may be more important. Cessation of sexual activity is not associated with menopause, and many women, freed from the risk of conception, seek intercourse and report heightened sexual satisfaction. Hysterectomy can generate an emotional crisis for women...

Relationships

The quality of a woman's relationship is a most important aspect of a women's sexual response cycle.28 The physical, emotional, and sexual satisfaction of the relationship enhance sexual interest and arousal. This can be a potentially turbulent time for women in heterosexual relationships. Extra-relationship affairs are reportedly highest in the thirties and forties, with contributors including a need to reconfirm sexual identities, relieve sexual boredom, companionship, improved sexual experiences, revenge, changing needs, and mental or physical impairment in a partner that stifles their full participation in a relationship. For women born between 1933 and 1942, 2.4 report extramarital affairs. Approximately 20 of those born between 1943 and 1952 and 14.5 of those born between 1953 and 1962 report extramarital affairs.2

Summary

Although decline in sexual activity is reported for aging women, in general women are no less interested in sexual activity as they age, but they and their sexual partners are affected more often by chronic illness and changes in physiology. Sexual difficulties remain common for mid-life and older women, 36 Heiman, J. R. and LoPicolo, J. Becoming Orgasmic A Sexual and Personal Growth Program for Women. New York Prentice Hall 1988.

Items 5356

A 22-year-old male abuser of intravenous heroin complains of severe headache while having sexual intercourse. Within a few minutes of that complaint, he develops right-sided weakness and becomes stuporous. His neurologic examination reveals neck stiffness as well as right arm and face weakness. An unenhanced emergency CT scan reveals a lesion of 3 to 4 cm in the cortex of the left parietal lobe. The addition of contrast enhancement reveals two other smaller lesions in the right frontal lobe but does not alter the appearance of the lesion in the left parietal lobe.

Items 6670

A 71-year-old man develops headache and slight difficulty speaking while having sexual intercourse. He has a long-standing history of hypertension, but has been on medication for more than 7 years. He makes frequent errors in finding words and follows complex commands somewhat inconsistently. The most obvious defect in his language function is his inability to repeat the simplest of phrases without making repeated errors. An emergency CT scan reveals an intracerebral hemorrhage in the left parietal lobe that appears to communicate with the lateral ventricle. (SELECT 1 DISTURBANCE)

Items 214216

A 29-year-old woman returns from a recent trip to India. She received no immunizations prior to her trip. She develops jaundice and right upper quadrant pain. She has mild hepatomegaly. She has no history of blood transfusions and uses condoms during sexual intercourse. She is not an intravenous drug abuser. (CHOOSE 2 ETIOLOGIES) 216. A 21-year-old woman presents with jaundice and hepatomegaly. She has nausea, vomiting, and diarrhea. She recalls eating raw oysters 1-2 mo ago. She has not traveled recently and denies drug use or unprotected sexual intercourse. She has no history of blood transfusion. (CHOOSE 1 ETIOLOGY) Items 217-218

When do I tell them

The location of the skin problem may mean that it is not immediately visible and so the decision as to whether and when the person will tell others can be delayed. If, for example, the condition affects the chest or the back, then these may not be visible while the person is clothed. Problems may first arise in situations where the person has to remove their clothing, i.e. when changing clothes, having sexual relations or at a public swimming pool. Some people use elaborate explanations as to why they are unable to engage in activities such as tanning or having sex with their partner. Sandra, a 29-year-old eczema sufferer, describes one such situation.

Situation

A dialysis technician working in a kidney dialysis unit is hepatitis B-antigen positive. The technician seeks advice from her personal physician regarding this disease, which can be transmitted sexually or by exposure to blood. She expresses a reluctance to inform family and friends or limit professional activities. In this case, there is no significant threat, as infectivity is low. In addition, kidney dialysis patients are routinely immunized. Therefore, the technician's interests take precedence over the public safety. The physician should counsel the patient about using universal precautions and taking special care to protect patients from exposure to her blood. But, there is no need to report the technician to her superior (If there were a high risk of infection, there might be an obligation to report the incident to the health care provider's superior.) The technician should, however, receive counseling on her personal life and the use of proper sexual precautions. The decision...

Exhibitionism

HPI The patient fears that he is abnormal and that he will not be able to have a regular sex life because women will not understand his desires. He adds that he has never had a sexual relationship or encounter, although lie is somewhat attracted to women. His medical history is unremarkable.

Outcomes

Weight loss, possibly in association with changes in the gastrointestinal hormonal milieu, results in dramatic effects on the comorbid conditions of severe obesity (1). Reversal or improvement have been seen for the following comorbidities type 2 diabetes (11), hyperlipidemia, hypertension, obstructive sleep apnea, weight-bearing osteoar-thritis, gastroesophageal reflux disease, and depression. Reversal or improvement are reasonable and presumed for other comorbidities, including cardiac and peripheral vascular disease, and carcinomas of the breast, uterus, ovary, prostate, colon, pancreas, and liver (10). There are also improvements in quality-of-life factors related to body image, personal hygiene, sexual activity, employment opportunities, and socioeconomic status (1). Finally, growing epidemiological evidence suggests that weight-loss surgery may increase longevity (41).

Herpes

A 17-year-old sexually active boy presents to the physician because of painful ulcerations on his glans penis and on the shaft of his penis. He has multiple sexual partners and does not use condoms. Fever and inguinal adenopathy are also present. Risk Factors Etiology. Genital herpes is usually caused by HSV-2 and is more commonly seen in teenagers and adults. It is transmitted by sexual activity. Complications Follow-up. Genital herpes is a risk factor for HIV. Genital herpes virus may reoccur without symptoms. During this recurrent infection, herpes virus is being shed and sexual partners are at risk. If the female patient with recurrent genital herpes is pregnant and has active herpes infection, then the infant passing through the birth canal is at risk for acquiring infection.

Review Questions

A 16-year-old female patient with a long history of epileptic seizures that could not be controlled pharmacologically had part of her brain ablated bilaterally. Afterward she is unable to identify friends and family members. She goes on eating binges, exhibits a tendency for heightened sexual activity, and seems unable to respond with appropriate emotions to externa stimuli. What neural structure may have been removed bilaterally

Anatomy Vulva

The hymen is a diaphragm of loose fibrous tissue covered on both sides by mucous membrane that demarcates the vestibule from the vagina. Before first intercourse, the hymen is of variable shape, but often crescentic and covering only the posterior margin of the vaginal orifice. Less commonly, it may be more complete, but usually still contains one or two openings. At first intercourse, there will often be tearing of the hymen to produce fissures. The appearance of the hymen has been used since time immemorial to determine whether penetration has taken place however, recent studies of prepubertal non-sexually abused girls indicate a wide range of normal appearance (4,5). Changes that were considered the result of sexual abuse, including a gaping introitus, may be seen in nonabused girls, and may be difficult to distinguish from changes induced by sexual penetration. The tags of mucous membrane following fissuring of the hymen are called the caruncles hymenalis or carunculae...

Trauma

In the emergency care setting, traumatic injuries to the vulva may be seen. Accidental injuries may occur in the setting of athletic activities such as bicycling or from a fall, and may cause lacerations or hematomas. Sexual assault and accidental injuries associated with sexual activity are the most common cause of vulvar trauma (7). Obstetrical lacerations and episiotomies may be associated with chronic peri-neal pain as well as the formation of neuromas or scar tissue. Genital piercing is becoming increasingly common and generally involves the labia minora or clitoris. It may be associated with cellulitis or trauma during sexual activity. Chronic pain, recurrent vaginal infections, sebaceous and inclusion cysts, urinary incontinence, difficulty with sexual activity, and obstetrical complications are all potential sequelae (10).

Infectious Diseases

A 25-year-old heterosexual man develops a urethral discharge and dysuria 5 days after having unprotected sexual intercourse with a new partner. Physical examination reveals meatal erythema. There are no penile lesions and no inguinal lymphadenopathy. A purulent ure-thral discharge is evident. Gram stain of the discharge reveals neu-trophils and intracellular gramnegative diplococci and the patient is treated for Neisseria gonorrhoeae. Two weeks after antibiotic therapy (ceftriaxone intramuscular injection), the patient returns with a clear urethral discharge and dys-uria. Gram stain reveals many neu-trophils but no organisms. Which of the following is the most likely diagnosis 429. A 19-year-old previously healthy college student presents with a 5-day history of fever, generalized malaise, and sore throat. He denies cough. He does not use illicit drugs and uses condoms with his one sexual partner. He has been vaccinated against hepatitis B. On physical examination the patient...

Bacterial Vaginosis

Bacterial vaginosis is polymicrobial in origin and caused by changes in the normal vaginal flora. It primarily affects reproductive-age women and is associated with sexual activity, although transmission is not fully understood. Risk factors include multiple sexual partners, a new sexual partner, non-white race, previous pregnancy, intrauterine device, and use of douches. There is a reduction of hydrogen peroxide-producing lactobacilli and an increased growth of Gardnerella vaginalis and gram-negative anaerobes such as Mycoplasma hominis, Prevotella species, Peptostreptococcus species, Bacteroides, and Mobiluncus. An increased production of amines and alkalinization of the vaginal discharge create the characteristic fishy odor. Bacterial vaginosis facilitates transmission of HIV and other sexually transmitted diseases (29). In addition, vaginal shedding of HIV is increased in the presence of bacterial vaginosis (30). Several studies have shown that bacterial vagi-nosis is associated...

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A 28-year-old patient GoPoAo comes for her first prenatal visit at 6 weeks of pregnancy. Her examination is normal for gestational age. Her history reveals that she does not smoke. She drinks one glass of wine about two days a week. She has been married for three years and has only her husband as a sexual partner. She is employed as a paralegal. Her family history is negative. She is very concerned about preserving the mental and physical health of her baby. Which of the following interventions is most likely to reduce the risk of neurological defect in the infant

Answers

The answers are 72-b, 73-a. (Fitzpatrick, 3 e, pp 540-553.) Sezary syndrome is a cutaneous T-cell lymphoma (also called mycosis fungoides) characterized by an erythroderma (a generalized erythema, scaling, and thickening of the skin) and leukocytosis. Abnormal circulating T cells (Sezary type) are seen on buffy coat. Adult T-cell leukemia lym-phoma is a neoplasm caused by the retrovirus human T-cell lymphotrophic virus I (HTLV-I) and manifested by skin lesions, lymphadenopathy, hyper-calcemia, lytic bone lesions, internal organ involvement, and abnormal lymphocytes on the peripheral blood smear (polylobulated lymphocytes). It is transmitted through blood products and through sexual intercourse and may occur 20 years after exposure. Skin lesions may be single, multiple, or generalized. Cutaneous B-cell lymphoma is a rare clonal proliferation of B-lymphocytes often associated with systemic B-cell lymphoma. 74-76. The answers are 74-c, 75-h, 76-b. (Fitzpatrick, 3 e, pp 208-227,...

Orchitis

Discussion Eighty percent of UTIs are caused by E. coir, Staphylococcus saprophytics is the second most common cause. Other causes, in order of frequency, arc Proteus, Klebsiella, Enterobacter, Serratia, Pseudomonas, and Enterococcus Chlamydia and Neisseria are also causes of urethritis. Risk factors includefemale gender, sexual activity, pregnancy, obstruction, bladder dysfunction, vesicoureteral reflux, and catheterization. JJU J p. 191

Human Papillomavirus

Hyperpigmented Labia

Common, plantar, and flat warts are examples of extragenital skin lesions. Genitomucosal lesions can be associated with significant clinical disease. HPV types 6 and 11 are most often associated with benign disease or low-grade cervical intraepithelial neoplasia. High-grade cervical intraepithelial neoplasia (CIN), cervical squamous cell carcinoma, vulvar intraepithelial neoplasia, vaginal intraepithelial neoplasia, penile cancer, and anal cancers are traditionally associated with high-risk HPV types 16 and 18. Although 50 of the reproductive age population exhibits signs of exposure to HPV infection, only 1 to 2 of the adult population actively manifests clinical genital warts (11,12). Identifiable risk factors for genital warts and cervical dysplasia include multiple sexual partners, sexual activity at an early age, history of other sexually transmitted diseases, age of first pregnancy, previous abnormal Pap smear, cigarette smoking, poor diet, poor hygiene and immuno-compromised...

Medical Histories

Human immunodeficiency virus (HIV) infection, or AIDS as it was originally called, causes death by destroying the patient's immune system. More simply, the patient dies from an infection because the body's defense system does not work. This virus is very difficult to transmit from one person to another. A dental care provider cannot contract an HIV infection through daily contact at the workplace. The HIV infection enters the bloodstream by having sex with an infected person or by shooting drugs with a needle or syringe that has been used by an infected person. If you work on an HIV positive patient, the patient is many more times at risk than you are. The reason is the patient's immune system cannot easily control new and different infections. It is important, then, to have extremely strict aseptic procedures before, during, and after patient care. This reduces the risk to the HIV patient and the possibility of risk to other patients and the dental care providers.

Sexual Dysfunction

A 31-year-old woman, mother of four children, comes to the office stating she has little interest in sexual intercourse with her husband for the past year. She says sex is painful, but she is able to experience orgasm occasionally. She has had no other sexual partners than her husband. These problems are affecting her marriage. She had a tubal sterilization procedure performed after her last delivery 2 years ago. Medications she is taking include thyroid replacement and fluoxetine. Desire. In both women and men the desire for sexual activity is also known as libido. Desire is maintained by a balance between dopamine stimulation and serotonin inhibition. The threshold of response is determined by androgens, especially testosterone. Orgasm. This phase is mediated by sympathetic connections resulting in reflex tonic-clonk muscle contractions of the pelvic floor followed by contractions of the uterus. Women have more individual orgasmic variability than men. A unique characteristic of...

Combined Methods

In this family planning method, a woman is given injections of hormones every 1 to 3 months, usually at a health center or family planning clinic, by someone who knows how. The first injection can be given any time a woman and her health worker are reasonably sure the woman is not pregnant. The injection protects against pregnancy immediately if it is given within 5 days after monthly bleeding begins. If the injection is given 6 or more days after the beginning of monthly bleeding, the woman and her partner should use condoms or not have sex for the next 2 weeks. For more information see page 396.

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