Health related information and news from around the world. » Men’s Health-Erectile Dysfunction

ISD AND THE MIND: REMOTE CAUSES OF ISD

admin — Mon, 28 Mar 2011 09:01:17 +0000

Compared to immediate concerns, which you may be able to recognize and connect to your sexual problems, remote causes of ISD are even more difficult to identify. Indeed, they tend to operate subconsciously and may involve influences from the past. In other instances, you will recognize the issue but fail to understand the source of the problem, believing that you could not possibly be inhibiting your desire because of events or feelings you are sure you “got over” years ago. This was certainly the case for:
• Janet, who truly loved and fully trusted Tim but was terrified by the thought of having sex with him
• Wendy, who lost all sexual desire six months before her husband’s death and has yet to get it back, even though she is now in love with a man whom she once considered extremely sexy and desirable
• Maggie, who wants to have sex so that she can please and hold on to her husband, but feels anxious, out of control, and turned off every time she thinks about sex
• Larry, who was given a clean bill of health two years after having a heart attack, but is still unable to feel any interest in sex
Like many of the other ISD sufferers and desire discrepancy couples who appear in this book, they are living proof that ISD is, more often than not, a case of mind over matter. While they want to enjoy sexual desire, they rarely or never do. Indeed, when they should be “all systems go,” they unconsciously go on red alert status instead, shutting down the circuits that receive and transmit sexual messages. Because this process often takes place without their conscious awareness, they don’t know what’s happening, or why it’s happening, or that anything is happening at all.
For instance, Larry, the heart attack victim, was initially convinced that his body had undergone a drastic chemical change that had robbed him of his sex drive. But there was no physical reason for Larry’s global loss of desire. In fact, although he vehemently denied it at first, tucked in the back of Larry’s mind was the idea that having sex would set off another heart attack, this time a fatal one. Strongly related to his current fear are his unresolved feelings about his father’s death, which occurred when Larry was seven. Rather than admit to his fear of dying during sex or take the risk of disproving it, Larry, without knowing he was doing it, protected himself by not feeling sexual desire.
Of course, when ISD patients come to us for treatment, we attempt to identify the immediate and/or remote causes of their condition, and try to determine if there might be a physical cause. If there doesn’t seem to be any immediate cause or if it doesn’t respond to short-term sex therapy, we explore deeper, more complicated psychological issues, many of which we will discuss in the remainder of this chapter. In treating patients who mistrust a partner who is, in reality, loving and giving, or those who experience unprovoked anger, extreme anxiety, or total numbness in sexual situations, we look for and often find underlying fears—like Larry’s—that are the cause of their ISD.
*93\261\8*

BEFORE THE POSTNATAL EXAMINATION – PELVIC INFECTION

admin — Tue, 07 Apr 2009 07:26:45 +0000

The health visitor hoped that the doctor would agree to put a coil in with the baby only four weeks old. At least the lochia had stopped and, fortunately, Linda had no record of pelvic infection. The coil might be expelled or Linda might bleed, and there was a higher risk of perforation, but the doctor was skilled. Most important of all, Linda knew she had been allowed to choose and even if it was not the ideal method, it was the only one acceptable to her.

For many women, however, the commonest means of contraception before the six week postnatal visit is abstinence. It is possible that those who do resume intercourse do so for reasons other than their own sexual desire. Some will do so to please their partner. When intercourse has not been possible for a time previously, he may need reassurance that he is still loved and needed despite the advent of the new baby.

*170/197/1*

THE STEREOTYPES – ‘MAN THE HUNTER’

admin — Tue, 07 Apr 2009 07:20:34 +0000

The active, predatory young and older men who described the hunting phase of their lives in detail, were at pains to explain how they were different. They pointed out that they were just as much approached by women as making the first moves themselves.

It is well known that enquiring about those things that an individual dislikes in others may uncover feelings about the parts of himself with which he is uncomfortable: what has been described as his hidden shadow (Samuels, 1985). A man may imply, ‘Others behave like this all the time, but I am different.’ In the next breath he is likely to explain that all men have an instinct to prey on women.

Does contraception come into this at all? This author believes it does, for contraception may be seen as a defence from being preyed upon (trapped in pregnancy). It can also be a protection against sexually transmitted disease, and it can be a useful barrier for those men who do not want too much emotional closeness with a woman.

*133/197/1*

FACTORS IN UNPLANNED PREGNANCY – ATTENTION SEEKING

admin — Tue, 07 Apr 2009 07:14:10 +0000

Women may become pregnant in an attempt to draw attention to themselves and their difficulties (Blair, 1983).

Miss I. is 25 but looks younger. She had initially thought of keeping her baby but realized this was only a form of rebellion and not likely to be beneficial to her or the baby. When her boyfriend had found out she was pregnant he had hit her. Her mother had told her to throw the baby out in the rubbish. She felt alone and abused. Her previous boyfriend had been no good and had given her gonorrhoea. She could see all her relationships were harmful to her and talked of her unhappy childhood. A psychotherapy referral was offered and accepted readily.

*96/197/1*

CARE OF THE YOUNGER PATIENT – HOW THEY COME (CONCLUSION)

admin — Tue, 07 Apr 2009 07:07:18 +0000

Four young people asked to see the doctor together. One man, rather older than the others acted as spokesman, and it quickly became apparent that he was the moving force behind their attendance. After a short while it was possible to split them up into the two couples, and later to see them individually. The older man’s own girlfriend felt she was being pressured to go on the Pill because he did not like using sheaths. Personally she had no wish to do so at this stage, and with the support of the doctor she was able to tell her boyfriend how she felt. Giving him an opportunity to air his own views at the beginning appeared to have made it easier for him to accept her ideas, and they were supplied with some more sheaths. Later she returned asking for the Pill, feeling now that she loved him enough to want to do this for him. The other couple had not started to make love and were on an exploratory visit to the clinic, perhaps partly swept along by their friend’s need of support. A few months later and they came back on their own and she started the COC.

*59/197/1*

CONFLICT IN RELATIONSHIPS – PREGNANCY AND CONTRACEPTION

admin — Tue, 07 Apr 2009 06:59:02 +0000

Allowing a pregnancy to happen by using contraception erratically can be a way of testing the relationship and holding on to a partner. If only one of the partners wants a pregnancy, methods may be sabotaged. Pregnancy can be used to control the woman, especially if there is violence in the relationship. A man who is adamant that his woman’s place is in the home may fear loss of control if he does not keep her constantly pregnant. Sometimes cultural and religious views can be called upon to defend the man’s position.

Mr G., an unemployed partially sighted Bangladeshi man, is the father of 11 children and the grandfather of five. Initially, he seemed to accept the fact that his wife was receiving contraceptive advice. He spoke good English although his wife did not. A linkworker was brought in to help interpret. The Pill was chosen and the wife beamed her approval. All went well for about a year but then Mr G. forbade his wife to take it any more insisting that she have another baby as their Moslem religion instructed. It appeared that Mrs G. had no say in the matter and went on to have her twelfth child at the age of 42 years. At her postnatal visit she looked tired and defeated, but Mr G. beamed in triumph and refused to allow his wife to use contraception. The doctor felt angry and frustrated but nothing could be done.

It seems that in this marriage Mr G. felt that his authority was being threatened, perhaps because he was no longer the wage earner, and perhaps as a result of his sense of not being fully in control because of his poor vision. The only way he seemed able to reassert his position was by the use of his fertility.

*22/197/1*

CONTRACEPTION, PLANNING A FAMILY AND INFERTILITY: CONDOMS

admin — Fri, 27 Mar 2009 08:43:50 +0000

Barrier methods-There are several barrier methods and more people are using them than in the past.

Condoms-The commonest is the condom. The male version may burst and the correct method of usage to reduce this hazard is shown in the diagram. The advantages are that it cuts down the risk of infection, is widely available, is available free from clinics, and requires no prescription. It causes impotence in some men but can prolong the performance of premature ejaculators. For the same reason some men say that it is like wearing a Wellington on the penis and some women object to it as being ‘unloving’. Women with a fear of semen can find its use an advantage. It should be used from the commencement of sexual proceedings and if the woman puts it on the man it can become an enjoyable part of foreplay. It is usually lubricated. One brand provides a pessary of nonoxynol-9, which kills both sperms and HIV along with the condom. The pessary is placed in the vagina and thereby provides additional protection. The condom is far from foolproof but with careful and conscientious use failure rates can be brought down from the usual 14 to 1 or z pregnancies per hundred woman years.

Clinical trials are under way with the female condom. It amounts to a plastic bag, about three times wider than a male condom, sealed at one end and with a springy plastic ring at the open end. The closed end is put in the vagina and another loose ring is inserted to keep the device in place. The ring at the open end prevents this from slipping into the vagina. Men say they prefer it to the male condom and some women say that it improves their orgasm – perhaps due to the outer ring rubbing the clitoris.

The use of a sheath: Used carefully, a sheath can be a very safe method of contraception.

1) Squeeze air out of teat and apply sheath to penis after placing a few drops of spermicide inside.

2) Unroll the sheath along the length of the penis 3) using other hand to ease it back towards the head of the penis.

4) When the sheath is on completely it should be totally unrolled and the packing rings should still be visible.

5) Withdraw shortly after orgasm keeping a finger or two on the base of the sheath as you withdraw.

*119\164\2*

INTERCOURSE: THE FIRST TIME

admin — Fri, 27 Mar 2009 08:38:41 +0000

A man, although he may not be consciously aware of it, can be disabled by a fear which probably took root in the Oedipal stage of childhood but which now emerges as fear of failure, getting his partner pregnant, or of catching VD or AIDS. Consciously he may think he is just over-excited but he may experience difficulty erecting; a loss of erection; ejaculation prior to penetration or as soon as it is accomplished; an inability to penetrate; and so on. One way or another intercourse is thus avoided. The only sensible advice is not to worry, to accept that such problems are commonplace, and to keep on trying. Prior masturbation to orgasm steadies the nerves of some and, given that a young man can erect again quickly, he can have a second attempt.

Similar apprehensions sometimes afflict girls. If a girl is too tense the muscles around the entrance of her vagina contract making penetration difficult, painful, or even impossible. The techniques mentioned for dealing with painful intercourse in the ‘Sexual Difficulties’ chapter will be useful at such times.

Girls can help themselves before first attempting intercourse by using tampons, thereby breaking or stretching the hymen. Some use their fingers (or similar objects) in the vagina as a part of masturbation, accompanied by fantasies of being penetrated. The entrance to the vagina can be very tight in an inexperienced female but, unless she is unduly afraid, stretching the area is usually a pleasurable sensation.

Fears of intercourse can be so excessive in some women that penetration is never achieved. Any attempt leads to closing the thighs, arching the back and screaming. Such women often marry men who have their own anxieties about intercourse and after many years of marriage the women are still virgins. Usually it is their desire to become pregnant which brings them to the notice of the medical profession.

These are extreme cases with underlying serious psychosexual problems which do not affect most women. The perfectly normal apprehensions and fears of virgins about to undertake intercourse can be overcome by the techniques of adjustment mentioned earlier under ‘Courtship’ and by setting the scene suitably. For example, contraception should be sorted out prior to first intercourse; a location where disturbance is unlikely should be selected; sufficient foreplay to induce copious lubrication should be undertaken (or KY jelly used to reduce friction); and the woman should be so sure she wants to do it that she is eager and excited about it. If these ‘conditions’ aren’t met or nearly met it is best to remain at the level of mutual masturbation for a further period of time.

The young can be very disappointed with themselves and their early intercourse experiences. Although intercourse may be natural it is, like everything else in life, also a skill which needs mastering. Due to the anti-sexual nature of our western culture it takes most couples time to overcome their underlying fears and embarrassments. On average it seems to take about five years to become proficient at sex, even with a helpful partner.

*99\164\2*

SEX DIFFERENCES: THE BIOLOGICAL APPROACH-HERMAPHRODITES

admin — Fri, 27 Mar 2009 08:25:46 +0000

True hermaphrodites (a very rare condition) are individuals with both male and female chracteristics. Sometimes they have two XX chromosomes (as in a female) and normal female internal reproductive organs but with the external genitals being composed of male and female organs. Such people can thus have both ovaries and testes. Because such babies cannot easily be ‘sexed’ at birth they have been valuable in studying sex difference, because a biologically male infant can be brought up as a female and a female reared as a male. Sometimes the illogicality of the rearing is not apparent until puberty when the biological sex and the gender role clearly do not match up. Research has found that a change of gender role before the age of two and a half years is easily tolerated by the child and no harm is done. After that age there are increasing emotional and psychological disturbances which can last into adult life. So this type of evidence suggests that sexual identity is firmly established in the first three years of life. First signs begin to appear as early as one year old.

In hermaphrodites there seems to be a considerable preference for the gender role that they have been given at birth and by which they have been brought up — even when this goes against the obvious physical sexual identity.

Turner’s Syndrome is a condition that arises when the baby’s cells have only one sex chromosome instead of two. The cells are chromosomally XO (instead of XY or XX). Such children are female but fail to develop or to mature sexually and may be mentally retarded. One study of thirteen such girls showed that although they had no sex hormones they all had ‘typically feminine’ day-dreams, fantasies of marriage, romance and heterosexual eroticism. So in spite of having only one X chromosome they behaved in certain ways like females with two. This and other work seems to suggest that biological sex is much more important than gender allocated sex.

Transsexualism occurs when a person feels that he or she belongs to the opposite sex in spite of perfectly normal physical evidence to the contrary. No one has any certain idea why this occurs and it is nothing to do with either transvestism (dressing up in clothes of the opposite sex) or homosexuality. Parents treating a child as if it belonged to the opposite sex may be important.

*79\164\2*

WHAT TO DO WHEN MARRIAGE GOES WRONG: YOUR GENERAL PRACTITIONER, SELF-HELP AND VOLUNTARY ORGANISATIONS

admin — Fri, 27 Mar 2009 08:18:02 +0000

Many of the self-help organisations that offer counselling services are listed at the back of the book. You will see that many of these specialise in specific areas; so be careful which one you contact so as to be sure of getting the best possible help. Many such organisations have trained psychologists (who are not doctors but are trained in the normal workings of the mind) on hand. Psychologists can actually be more helpful than doctors in many cases because more often than not individuals with sexual or relationship problems are not ill and do not need a medical mind to sort them out. The strength of the nonmedical specialist is that the individual does not go along thinking that there is a magic operation or bottle of pills to answer his problems.

Your general practitioner-He or she will probably have no specialist training in this field but should be quite helpful as a result of dealing with similar problems time and time again. A general practitioner can rarely spare much time but can sometimes refer you to other people who are more expert and have more time.

*59\164\2*