Archive for the ‘Men’s Health-Erectile Dysfunction’ Category

posted by admin on Mar 30

You suspected it for a long time, and now you know for sure: You’ve got BPH. What should you do? Do you need to be treated, and if so, how? With surgery, medication, or another form of treatment? Or, should you just wait a while, and see whether your symptoms get worse?

If your symptoms are mild and you can live with them, you should consider watchful waiting. This doesn’t mean “do nothing.” It means “wait and see.”

A lot of men with BPH, consciously or not, plan their day around trips to the bathroom. What about you? Has BPH started to intrude on your life? Can you still do everything you want to do? If not, do you want treatment badly enough to run the risk of side effects or complications? If you’re somewhere in between these two extremes of BPH mentioned above, there are many options for you to consider. Read about them, weigh the risks and benefits of each, and discuss them with your doctor.

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posted by admin on Mar 30

Incontinence affects from 2 percent to 4 percent of men who have a TUR. It can have several causes: One is damage during surgery to the external sphincter—the valve that opens and shuts at the junction between the prostate and urethra (see figure 5.1). Another is a bladder that’s been damaged and rendered hypersensitive by months or years of urinary obstruction from BPH; it might be that surgery has come too late to undo the years of damage. A third possibility is that there’s some residual prostatic tissue blocking the urethra, which either is holding the external sphincter open or is obstructing the urethra, producing overflow incontinence.

Most men experience temporary urgency and stress incontinence after the catheter is removed; it takes the urethra hours to days to recover from being stretched or irritated by having the catheter inside. There’s also something you can do to help control stress incontinence—Kegel exercises, which strengthen the external sphincter. The best way to do them is when standing to urinate: Try to start and stop your urinary stream by contracting the muscles in your buttocks. There are other methods of performing Kegel exercises, but by doing them this way you can be sure you’re exercising the right muscles.

If incontinence doesn’t get better over time, your doctor may do cystometry to determine the state of the bladder, or check with a cystoscope to make sure there’s no residual prostatic tissue blocking the urethra. Some drugs may also help: If you have urgency incontinence, for example, anticholinergic drugs can help stop involuntary bladder contractions. For stress incontinence, drugs that cause smooth muscle tissue to contract—such as nasal decongestants, or even an antidepressant that often makes it more difficult to urinate (a drug called imiprimine)—can help. If incontinence persists for more than a year, or is severe, your doctor may suggest further treatment—possibly placement of an artificial sphincter. In this procedure, a rubbery cuff is positioned around the urethra and connected by tubing to a reservoir for fluid that’s installed in the abdomen, and to a small pump, placed in the scrotum. The pump transfers fluid from the reservoir to inflate the cuff (and block the urethra), and a valve next to the pump can be released to deflate the cuff and allow urine to pass through the urethra. The artificial sphincter is an elaborate device; but there are several simpler solutions that involve injecting material (collagen) into the tissue around the urethra or bladder neck. It’s possible that with further refinements, these techniques will be sufficient for managing incontinence in almost all men who develop it.

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posted by admin on Mar 30

Penile implants, or prostheses, are available in several varieties; the simplest are bendable, and the more complicated ones are inflatable or mechanical. The implants are not a new idea, but they have improved considerably since they were first introduced about twenty years ago. The bendable prostheses, for example, were exactly the same size all the time—whether or not the penis was in the erect position—which, as you can imagine, often proved awkward in social settings. Earlier models of the inflatable prostheses that did allow for a “non-erect” size sometimes failed to work and needed to be replaced.

If these relatively clumsy but functional early designs were the prosthetic equivalent of the typewriter, then the latest models are more like a Macintosh computer—sleek, sophisticated and user-friendly They are more reliable, easier for surgeons to implant, and are designed to look more natural in the “non-erect” phase—even the bendable prostheses, which are more malleable than before. And they can restore sexual function entirely to normal.

Some of the more complicated devices involve a pump and a reservoir for fluid, housed in the abdomen or scrotum, and inflatable chambers, which are placed in the corpora cavernosa. (Fluid is pumped into the penis to create an erection and is then held there by a valve. Afterward, the valve is released, and the fluid returns to the reservoir.)

Penile prostheses used to be offered routinely to most impotent men. Now, with other good treatments available, many urologists have come to regard penile prostheses as a last resort because they do involve surgery—and thus, they carry the risk of complications. These can include infection, scarring, damage within the corpora cavernosa, or a problem with any part of the prosthesis. However, these side effects are relatively rare. Most men who have penile prostheses are satisfied with the result and have a normal sex life.

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posted by admin on Mar 30

The big advantage of the combined therapy is that it seems to stretch out the time that hormones work—the time to progression of cancer is lengthened by several months. However, overall survival is not significantly better for the men on the combined treatment. In a huge analysis of about five thousand prostate cancer patients in Europe and America, doctors studied overall survival and found, at five years after treatment, a 3 percent difference between the men on total androgen blockade and the men who underwent castration or took LHRH agonists alone. This is not a stunning display of the success of total androgen blockade.

And, after a certain point, some patients actually benefit from stopping flutamide. For example, when a man taking flutamide in combined therapy begins to relapse—when his prostate cancer begins growing again, and his PSA level goes up—one step his doctors should take right away is to stop the flutamide. In from 40 to 75 percent of these men, PSA levels drop when flutamide is stopped. Paradoxically, flu amide can make some patients—who initially were helped by it—worse. Exactly why this happens is not clear. In certain prostate cancers, over time, the androgen receptors (the part of the cell responsive to hormones) undergo a mutation—and all of a sudden, flutamide stimulates the cancer. Remember, flu amide normally acts like a dummy key in the “lock” (the receptor), whose purpose is to block testosterone and DHT from activating the receptor. With this mutation, however, the flutamide key actually works—it turns in the lock and activates the receptor.

There is one crucial concept here that you need to understand: Ultimately, total androgen blockade is going to stop working, just as every other kind of hormone therapy does. Anyone who leads you to believe otherwise is not doing you a favor. And when hormone treatment stops working, it’s not because of the tiny amounts of testosterone and DHT being made by the adrenal androgens—in other words, it’s not the fault of some renegade hormones that are sneaking through the hormonal blockade. It’s because of the hormonally independent portion of the cancer—the cells that couldn’t care less what hormones its host is taking, because hormones have no effect on this portion of the tumor. Using hormones to fight these cells is like trying to kill a cockroach with hair spray instead of insecticide. The problem is, we haven’t found the right “Raid” yet.

As one Johns Hopkins molecular biologist explains, “Cancer cells are very efficient. And as they keep dividing, they jettison some dead weight. One of the first pieces of unnecessary baggage to go may be the system of controls—the part of the cell that takes orders from hormones. Over time, the deadliest cancer cells survive because they become pure, stripped-down growing machines.”

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posted by admin on Mar 30

The ideal patient for radioactive seeds is a man who is also ideally suited for external-beam radiation therapy and radical prostatectomy—and both of these treatments can cure prostate cancer in men with localized disease. So the question is, is interstitial brachytherapy equally good or better? And the answer for now is, probably not, although the treatment is continually improving. Before the development of sophisticated guidance systems, major problems arose from seeds being either too far apart or too close together, resulting in an uneven distribution of radiation throughout the prostate—some cancer cells were killed, but some weren’t. In many cases, the cancer returned, or never completely went away in the first place. Better placement may change this picture.

Radiation seeds are not recommended for men who have had a previous TUR procedure; for one thing, because they’ve had significant amounts of tissue around the urethra removed to alleviate their BPH symptoms, there’s not a lot left to hold the seeds in place.

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posted by admin on Mar 27

Only a third of the homosexual offenders vs. minors had married prior to being interviewed; only the homosexual offenders vs. adults had fewer married individuals. Accumulative incidence calculations lead us to suggest that only slightly more than half of these homosexual offenders vs. minors would ever marry. The average age at marriage was twenty-five years—the oldest age of any of our comparative groups and almost identical with that of the homosexual offenders vs. children.

Thanks to late marriages and the breakup of marriages, the homosexual offenders vs. minors spent more of their postpubertal lives as single (42 per cent) and divorced or widowed (30 per cent) than as married (28 per cent). This statement is true of only two other groups: the homosexual offenders vs. adults and the aggressors vs. minors.

Being more homosexually oriented than most, the homosexual offenders vs. minors were not very ready to marry a second time: two thirds of those who married did so only once. This same trend is seen more clearly among the homosexual offenders vs. adults. A rather large number, 37 per cent, had one short marriage—again a circumstance that appears more strongly among the homosexual offenders vs. adults.

In length of acquaintance before marriage and incidence of premarital coitus with their fianc?es, these offenders are in no way distinctive. The percentage of pregnant brides is somewhat low, as might be expected in a group in which frequencies of premarital coitus were also low.

Of all groups, the homosexual offenders vs. minors and adults were the least fertile; more than half fathered no children in marriage. For every ten offenders there were only nine offspring. This is amazing in the case of the homosexual offenders vs. minors, since their coital frequencies are rather high. Of the 20 (out of 46) men who had one or more children of their own, eight had two children, six had one, and three had three.

minors devoted a great deal of time to coital preliminaries with their wives, but neither are they notable for the brevity of foreplay. A somewhat small proportion, one third, had had mouth-genital contact with their wives, and about half as many had had both cunnilingus and fellation. Interestingly, more homosexual offenders vs. minors than any other group (13 per cent) had experienced only fellation. In a rank-order of those who had been fellated by their wives but who had never placed their mouths on their wives’ genitalia, the homosexual offenders rank first, third, and fifth. One wonders if this represents a technique preference carried over from homosexual experience, though this supposition is weakened by the fact that anal coitus, another technique that is employed in some homosexual relationships, is rather uncommon in the marriages of the homosexual offenders vs. minors and children.

Separation of the married from the unmarried homosexual offenders vs. minors results in a powerful selective effect that is best seen in a comparison of premarital and marital coitus. In premarital coitus these offenders revealed uniformly low frequencies; for the average (median) male it was about once in three weeks, which earns them a place near the bottom of the rank-orders. In marital coitus, however, they display unexpectedly high frequencies, the average individual ranking second or third from age twenty on with frequencies of 2 to 3 times a week. In the calculations of mean frequencies they rank second in age-periods 26-30 and 31-35. It is obvious that the married homosexual offenders vs. minors were, despite their offenses, primarily not only a heterosexual group but an active one. In this connection it should be noted that the great majority of these married offenders were not having homosexual activity: for example, in age-period 21-25 only four of the 22 married men had homosexual contacts; in age-period 26-30, four of 29; in age-period 31-35, six of 23; and in age-period 36-40, two of 13.

While one can point out the greater heterosexual and lesser homosexual orientation of the married men, this does not help explain why the frequencies of marital coitus are so high. The proportion of total sexual outlet constituted by such coitus is, however, best described as moderate, ranging from 82 to 89 per cent.

In their orgasmic response, the wives of the homosexual offenders vs. minors were more fortunate than most, if one can believe their husbands: in very few (4 per cent) of their marital years did they have low rates of orgasm and in a fair number (60 per cent) they achieved orgasm in at least nine out of ten coital acts.

The homosexual offenders vs. minors, like the other homosexual offenders, had marriages that are intermediate in a rank-order of marital happiness: about two thirds of their years of marriage were very happy to moderately happy.

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posted by admin on Mar 27

Seventeen per cent, a moderate proportion, of the incest offenders vs. minors had had sexual contact with animals of other species. The age-specific incidence (ranging down from 12 to 3 per cent) is similarly moderate. One would have expected them to occupy a higher place in the rank-order since they are the second most rural of all our comparative groups, half of them having either been rural all their lives or having lived on farms between ages five and eighteen. Their background not only failed to engender much animal contact; it also had no discernible effect on their fantasies and dreams. Indeed, no incest offender vs. minors (or adults) reported such dreams.

On the other hand, these offenders are second only to the incest offenders vs. In comparison to the percentages found among other groups these figures are very large.

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posted by admin on Mar 27

While most of the aggressors vs. adults were intermediate in rank-order of birth, they do display a small tendency to be the youngest children of the family (28 per cent). A similar tendency was seen in the aggressor vs. children, but the reverse was inexplicably true of the aggressor vs. minors. A very small percentage of aggressors vs. adults— but still a larger percentage than obtains for other groups—were raised alone despite having had siblings. They are also unusual in having fewer brothers than sisters, a characteristic of all three aggressor groups.

The aggressors vs. adults are not distinctive in their relationships to their fathers at ages fourteen to seventeen; about all that can be said is that they got along better with their fathers than did the aggressors vs. children and minors. This is in keeping with the general trend for heterosexual sex offenders whose objects were older to have had better paternal relationships than did sex offenders with younger objects. Their adjustment to their mothers is also unremarkable (although inferior to that of the prison and control groups) but better than that of the other heterosexual aggressors. In a rank-order of good adjustment with either father or mother, the aggressors are always in the lower half of the scale.

More aggressors vs. adults got along better with their mothers than equally well with both parents. As is true of all groups, fewest were partial to the father. This preference for the mother is shared by all the heterosexual aggressors.

Sixty per cent of the aggressors vs. adults came from broken homes, the third highest number of any of the groups and double the number of the control group. They differ from the other heterosexual aggressors only in having an unusually large number (24 per cent) of cases in which the breakup came after the age of nine. The relationship of their parents was about average when the boys were in their early and midteens, neither particularly better nor worse than that of parents of sex offenders as a whole. It was, however, inferior to the relationship that existed between the parents of the control- and prison-group individuals.

Largely because of the high percentage from broken homes, the aggressors vs. adults spent fewer of their early years in a home in which both a husband and wife were present. Sixty per cent had 15 or more such years, while the equivalent figure for the control group is 80 per cent. About 7 per cent had lived ten or more years of their early lives in households in which the adults were all women. In absolute, terms this is a small figure, but there may be some significance in the fact that it is the highest percentage manifested by any group guilty of heterosexual or homosexual offenses against adults. Also, a rather large proportion went to institutions after the breakup of the home.

In this they are similar to the other aggressors. As for the number and sex ratio of their companions at ages ten to eleven, nothing really distinctive appears. They seem to have had about as many female friends at that time as the control-group individuals, but both had fewer female companions than did most of the sex offenders.

adults had no prepubertal sex play. Whatever sex play the rest had was predominantly heterosexual —a trait shared with the aggressors vs. minors. Sixty-one per cent had had heterosexual play as opposed to 40 per cent with homosexual play, despite the greater availability of the latter. Moreover, while over a fourth had exclusively heterosexual experience (in this category the heterosexual aggressors are second, third, and fourth in rank-order) only 6 per cent had exclusively homosexual experience—the next smallest percentage of any group. This smallest, it may be recalled, was that of the aggressors vs. minors.

There is a tendency for the aggressors vs. adults to have had more years of prepubertal heterosexual play than most other groups; for 48 per cent it continued for three or more years. A study of the prepubertal heterosexual techniques reveals some interesting facts. In a rank-order of those who had coitus during this period, the heterosexual aggressors rank second, fourth, and fifth—the fourth being the aggressors vs. adults, with 69 per cent. With respect to mouth-genital contact, the aggressors vs. children ranked first with 15 per cent, and the aggressors vs. adults third with 12 per cent. To those of a psychoanalytic bent, this might suggest an oral-aggressive type, but this assumption is weakened by the fact that a similar proportion is shared by the peepers and the incest offenders vs. adults, and the fifth rank is occupied by the exhibitionists—these three types of sex offenders being the least aggressive of any.

The homosexual play of the aggressors vs. adults was of moderate duration: for 44 per cent of them it lasted three or more years. Nevertheless, the future aggressors vs. adults were prone to engage in the more specific and developed techniques. Twenty-seven per cent of those with homosexual play had had mouth-genital contact (fourth rank); a relative predilection for this technique was seen in the heterosexual play. Twenty-nine per cent had had anal intercourse, this percentage placing them in fourth rank just below the three homosexual offender groups. In this anal coitus these aggressors are generally the ones who inserted their penes into other boys and are seldom in the recipient role only.

About 10 per cent of the aggressors vs. adults had, while prepubescent, been sexually approached by adult females. Such overtures led to noncoital physical contact in 9 per cent of the cases (fifth in rank-order) and to coitus in between 4 and 5 per cent (fourth rank). Relatively speaking, the future aggressors vs. adults were an experienced group insofar as contact with older females was concerned, and far more experienced than the control group. Regarding homosexuality with adult males, they are intermediate in the rank-order.

Like the aggressors vs. minors, the aggressors vs. adults enjoyed good health during childhood. Here in percentage terms they are essentially identical with the aggressors vs. minors, who occupy third rank.

There is nothing distinctive about the aggressors vs. adults as far as their prepubertal masturbatory experience is concerned. As in the case of heterosexual offenders against females aged twelve or more, the incidence of those with prepubertal masturbation is below average.

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posted by admin on Mar 27

While the simple measure of “ever vs. never” incidence tells us nothing significant regarding the masturbatory history of heterosexual offenders vs. adults, the age-specific incidence tells a striking story. In any five-year age-period from sixteen on, except for age-period twenty-six to thirty, the single offenders vs. adults had fewer members masturbating than did any of the other groups except one. For example, between the ages of twenty-one and twenty-five, when 12 of the total of 15 groups of sex offenders and controls available for comparison had two thirds to 94 per cent of their members masturbating, only about half of the offenders vs. adults were doing so. Comparing solely the married men in our sample, the offenders vs. adults again display a low age-specific incidence. In addition to being low, the figures are curiously uniform: from age sixteen on to age thirty-five the percentages of persons with masturbatory experience within a five-year period range only from 22 to 24 per cent, and from age thirty-six to fifty only from

18 to 20 per cent. Such consistency is unique and suggests a sort of base line or irreducible minimum phenomenon.

Similarly, very few of the heterosexual offenders vs adults display high weekly frequencies: only 3 per cent had ever masturbated more than a dozen times in any one week (only one other group has a smaller percentage). Most (49 per cent) fall in the once-to-twice-a-week category.

Inspection of the average frequencies of masturbation among those engaging in this activity reveals that the single (never-married) heterosexual offenders vs. adults have, in general, quite low frequencies— the median being about once in two weeks following age fifteen; ordinarily only the incest offenders have lesser frequencies. By and large, one may say that the heterosexual offenders as a whole masturbate relatively infrequently, the offenders vs. minors less frequently than the offenders vs. children, and the offenders vs. adults least of all. As for the married offenders vs. adults who masturbated while married, one may summarize by saying that their masturbation frequencies tend to be low to moderate—usually low before age thirty-one and moderate thereafter.

As one might expect from the above, the percentage of total outlet (total orgasms) that the offenders vs. adults derived from masturbation is low. Among the single, the proportion is the smallest by far. For example, in age-period puberty-15 when the members of most groups derived two thirds or more of their orgasms from masturbation, the offenders vs. adults derived only 45 per cent; in age-period 21-25 when most others had from one third to two thirds of their outlet masturbatory, the offenders vs. adults had only one seventh.

The separated, divorced, and widowed males continue the tradition by ranking lowest in proportion of total outlet derived from masturbation from age sixteen up to age thirty-five and second lowest in age-period 36-40, with percentages of 4-6 per cent.

In this general de-emphasis of masturbation, these offenders are similar to the prison group.

Like the offenders vs. minors, the heterosexual offenders vs. adults display little tendency toward masturbatory fantasies; indeed, 18 per cent (the highest percentage) never fantasied at all. Within the various categories of fantasy—heterosexual, homosexual, sadistic, etc.— they always rank intermediate to low. None had sadomasochistic fantasies. This sexually successful group (in terms of heterosexual life) found their release in activity with females and relied little upon masturbation and sexual daydreaming. This de-emphasis of fantasy life is a part of a more general characteristic of these offenders: a relative unresponsiveness to psychic and visual stimuli.

Possibly because they masturbated so little they did not worry much about the supposed adverse effects. Whereas all our other comparative groups except the incest offenders vs. minors reported that they suffered anxiety during one third to three fifths of the years during which they masturbated, the offenders vs. adults reported worrying only 31 per cent of the time.

While the majority of the members of all groups learned of masturbation through observation and talking or reading, the offenders vs. adults had the third largest percentage (47 per cent) who learned in this fashion. Indeed, these offenders rank second (36 per cent) among those who learned from talking or reading only. Very few learned by being masturbated by another person, or invented masturbation by themselves. This heavy dependence upon seeing, hearing, or reading of masturbation is probably linked with their somewhat belated puberty —only 18 per cent were pubescent before thirteen, by which age discussion of masturbation is rife among boys—and with the relative paucity of prepubertal sex play.

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posted by admin on Mar 27

It is generally known that the education of prison inmates is substantially less than that of those never placed behind bars, but in our sample it also appears that the sex offenders received even less education than the members of the prison group. For example, 10 per cent of the sex offenders never went beyond the fourth grade, whereas the same can be said of but 5 per cent of the prison group. The figures for the proportion with some high school education are often slightly higher for the prison group than for the sex offenders. This discrepancy in educational attainment is largely explained by the difference in age: there has been in recent decades a continuous effort (usually backed up by statute) to keep young people in school until they are sixteen, by which time most are in high school. Since the members of our prison group are younger than those in all but two of our sex-offender groups, it is inescapable that they are somewhat better educated—or at least passed to higher grades—than the sex offenders as a whole.

The homosexual offenders, and particularly the homosexual offenders vs. adults, are aberrant in terms of education. Whereas only 2 to 9 per cent of the other sex-offender groups had some college education, the equivalent figures for the homosexual groups (beginning with offenders vs. children) are: 14, 15, and 31 per cent. These large percentages are due primarily if not wholly to a bias in our sampling. Virtually all other sex offenders were interviewed in prison, and consequently had the associated attributes—a poor education and little money—while more than a fourth of the homosexual offenders not only were interviewed outside prison, but many had never actually been imprisoned, because they had been given a suspended sentence, put on probation, or only fined. This is especially true of the homosexual offenders vs. adults, of whom nearly half were interviewed as members of free society. Some of these homosexual offenders vs. adults were obtained fortuitously, since they were members of social groups or organizations that we were sampling; others came as the result of a direct solicitation made through the Mattachine Society requesting any of its members who had ever been convicted for homosexuality to make arrangements with us for an interview. A substantial number of the respondents proved to have some college education.

adults is not wholly the result of our sampling: there is an actual positive correlation. As illustration, let us pose a question. If we take a group of college-educated men of modest to substantial means and generally law-abiding, and have them each occasionally and politely solicit some adult stranger for sexual activity, who are most apt to be arrested—those who solicit women or those who solicit other men? To put it another way, the educated man seeking heterosexual activity can fulfill his quest either within the law or at least with society’s tacit consent; the educated man seeking homosexual activity can do neither—his very choice of partner makes his action illegal and/or against society’s dictates.

If one subtracts the homosexual offenders from the total sex offenders, the educational attainment of the latter drops accordingly and the discrepancy between the sex offenders and the prison group is exacerbated.

Knowing the educational composition of our sex-offender and prison samples, we wished to make the control group’s educational status roughly equivalent with these two groups. Therefore, we excluded anyone with more than high school education. Even so, the control group on the average is distinctly better educated. The difference is most acute for those who had 11 to 12 years of schooling: slightly over half of them fall in this category in contrast to about one fifth of the prison group (21 per cent) and sex offenders (17 per cent).

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