Herbal Health

At this stage the family planning adviser is often seen as an intruder and rarely as the one with whom the patient can share her anxieties about the delivery or her concerns for the future. Nevertheless, some information about when it is considered safe to resume sexual intercourse, where to obtain contraception and how to use it is obviously desirable, if only to be referred to when the woman herself feels ready to consider sexual matters. Verbal information will need to be backed up by written information in the form of leaflets, and supplies of condoms may be given. If contraceptive pills are prescribed then written instructions on when and how to begin must be included, as much that is said during those first few days is probably not taken in or not remembered, and the woman’s preoccupation with other matters needs to be respected.

*163/197/1*

Mrs S. was desperate for a second child when she first arrived at the clinic. Her first child was conceived easily and was now about to start school. She had developed polycystic ovarian disease and was grossly overweight. A regime of ovulation induction was carried out successfully for six months but no pregnancy was achieved. The doctor was wondering how she could manage the next visit because she knew that Mrs S. could not afford an assisted conception programme. She need not have worried. Mrs S. hurried into the clinic saying that she had made up her own mind. ‘I’ve finished grieving for the baby that has not happened,’ she said. ‘I want to live my own life for a while. I’m starting a job next week.’ She had been through a lot of heartache, seeing friends and relatives with babies, but she had managed to lose some weight and with the help of the clinic staff she had been able to make her own choices.

Mrs S. had continuous support throughout her treatment in an environment where she had been encouraged to make her own decisions, including whether or not to have treatment, and when to stop. Others need more than this, especially when there is the added problem of mental or physical disability in the first baby. It is not just the obvious problem of managing to cope with another child at home, but consideration of whether there is a likelihood of the next baby having the same problem. Genetic advice must be sought, and discussions with a counsellor and perhaps self-help groups should be offered. Much of the personal assessment for the two individuals concerned is to do with how much fault they attribute to themselves for the disability in the child.

*126/197/1*

Miss F. was a West Indian aged 25. The decision for abortion had initially seemed straightforward. She intended to go to college later that year and a baby would prevent this. On the pre-operative round the doctor usually asks the patient if she is still sure about going ahead with the procedure. To her surprise this patient replied, ‘No, I’m not.’ It was suggested that she should not go ahead that day but make another appointment to see the doctor in the outpatient clinic. The nursing staff seemed pleased – a baby saved and a woman rescued in the nick of time (Potts er a/., 1977). Miss F. came back the next week. She had changed her mind because she had talked to her boyfriend who wanted her to have the baby and had made her feel guilty about having an abortion. However, he was unreliable, beat her up sometimes and was unlikely to modify his own life on the arrival of a baby. College was her chance to get away and make something of herself. She had her abortion the following week.

This woman changed her mind about abortion out of guilt rather than desire to have a baby. The guilt came from her boyfriend who seemed keen to keep her dependent on him. There were also cultural pressures as in her community it was more usual for girls to have babies than to go to college. She wanted to do something for herself and having a baby might have jeopardized her chances. Yet it would have been easy to believe at first that continuing the pregnancy would have been a good outcome.

*89/197/1*

Despite the wide variation in sexual and emotional maturity mentioned above, the majority of young people, who are in the throes of separation from parental dependence and embarking on a sexual life of their own, are doing so at a chronological age that lies within the normal limits for the society in which they live. Contact with doctors at this age is rare, so that even without its sexual connotation, the appointment with the doctor is special to the patient. Confidentiality is of paramount importance. Whoever is the first contact, be it a nurse, doctor or social worker (in those few clinics where one is available), a tone needs to be set which will allow the individual time to express needs and wishes. Each patient should be able to sense that this very important step in their life is being treated in confidence, as well as with respect and understanding.

*52/197/1*

One common “erection problem” isn’t really a potency problem at all. Sometimes a man has trouble maintaining an erection simply because he ejaculates too quickly. He may ejaculate before entering the vagina, or just seconds later.

If this sounds like you, it’s important to realize that you probably don’t have an erection problem. Since you can get an erection, your physical system is probably working just fine—just a bit too quickly for your taste.

If you’re a little confused by the term “premature ejaculation,” you’re not alone. Premature according to whom? Therapists don’t agree on a single definition of premature ejaculation.

Premature ejaculation can occur when a man is anxious, distracted or simply hasn’t had intercourse for a while and so is extremely sensitive to the sexual stimulation. For our purposes, let’s say that the problem is however you and your partner define it.

It is sometimes true that when premature ejaculation persists, a man will develop an erection problem caused by anxiety. The scenario goes like this: Jeff has a problem with early ejaculation. He tries to ignore his problem, but it persists. After a while Jeff is convinced he will always ejaculate too soon, and he develops anxiety about having sex. This performance anxiety can actually result in impotence. This scenario is avoidable, and persistent premature ejaculation can be successfully treated.

Sex therapy can work wonders with early ejaculation; success rates of 50 to 100 percent have been reported. At least one study suggests that couples can teach themselves to avoid premature ejaculation without much more than written instructions and telephone conversations with their therapists, There are exercises to prevent premature ejaculation: the stop-start method, developed by Dr. James Semans, and the squeeze technique of Masters and Johnson.

*208\184\8*

Semirigid Implants

Benefits

• The surgery can be performed under a local anesthetic, often on an outpatient basis.

• The recovery time is typically shorter than with the inflatables, because the surgery is less extensive.

• There is less chance of complications.

• There are no mechanical parts which can fail.

• These implants usually cost less.

Drawbacks

• The implant is more difficult to conceal since it is always erect. Some men may be embarrassed in locker room situations.

• Generally, the semirigid implants are less firm and smaller in circumference than an inflatable prosthesis when erect.

• Although the overall complication rate is lowerthan for inflatables, there is a small chance that the semirigid implant will”travel” within the penis, popping out of the corpora cavernosa. This situation can be corrected, but it does require removal of the implant and another operation.

Newer Inflatable Implants: Hydroflex and Flexi-Flate

Benefits

• The implant is similar to the semirigid type in its advantages: a short operating time, minimal postoperative complications, a short hospital stay or surgery on an outpatient basis.

• The implant is more concealable than the semirigid type.

• Total cost for the surgery may run less than that of other inflatables because of reduced hospital time, although the prosthesis itself is more expensive than semirigids or other types of inflatables.

Drawbacks

• The mechanical parts of the implant can fail. These new types haven’t been around long enough for anyone to know the long-term failure rate.

• The Flexi-Flate is deflated by bending it down towards the stomach. This limits the number of positions in which to have intercourse. For example, the woman-on-top position may not work because it causes the penis to bend down and thus deflate.

• The erection provided by the implant is like the erection of a semirigid prosthesis in that it doesn’t increase the diameter of the penis or the length, but only makes it harder and more rigid.

*149\184\8*

Sometimes men wonder why they should bother having any tests and histories done. Since there are so many effective treatments like penile implants, penile shots and sex therapy available, why not just fix the erection instead of spending time and money on complicated tests?

For one thing, the tests are useful for detecting any undiagnosed ailments. Your erection problems might be a symptom of another disease that could cause you a great deal of trouble. And only with the tests will the doctor be able to determine the simplest and best treatment for your particula situation. Also, if your doctor finds a physical cause for your impotence, your insurance policy is more likely to cover your medical expenses.

Here are some questions to ask before you have any test:

• Why do you think I should have this test?

• How accurate are the test results?

• How will the results help you give me better treatment?

• Are there any tests that cost less or are less painful, that will provide the same information?

• What complications or side effects could result from this test?

*119\184\8*

Cynthia’s experience illustrates some important points. A woman can see her partner’s erection as proof of her own desirability. If she’s insecure about her sexuality, an erection problem, even in a good marriage, can trigger a lot of painful emotions. And she may react as Cynthia did, by feeling rejected and not wanting to deal with the issue directly. communication problem might have been. Cynthia could have learned about the many causes of erection problems and understood the reasons for the tests; and perhaps a private discussion with the physician would have laid to rest many of her fears.

If you and your partner don’t discuss what is going on, there will be an information gap. And each of you will fill in this void by imagining what is happening to the other, and why. This will only lead to further problems.

For example, a man may wonder why his wife isn’t making their lack of intercourse an issue—doesn’t she enjoy sex with him? He may guess that she thinks him “less of a man.” He may become jealous, even if he’s never been jealous before. “In the back of his mind he questioned if I would be faithful,” remembers Terri, whose marriage of more than 20 years never had been troubled before by such doubts. “I felt this insecurity, and he mentioned it. This bothered me.” Fortunately, talking about the problem removed her husband’s fears that she would leave him.

And if s common, in the absence of other information, for a woman to assume that an erection problem is somehow her fault. While a woman who is very secure in her own self-image and in her relationship may not feel this way, many women take erection problems as a sign that something is wrong with them. Like Cynthia, they may feel they have done something wrong. Or they may see an erection as a sign that they are sexually attractive and capable, and see the lack as an indication of their own failure. The cure for such lack of communication: involvement, information and reassurance.

*90\184\8*

There are other considerations where the meaning of sex in a relationship is concerned. Here’s another case, very different from Rick’s. Arthur, at fifty-seven, had been married for thirty years when his hypertension-related ED brought him and his wife, Elaine, to my office. A very handsome couple, they emanated a feeling of togetherness.

“We’re really distressed at this development,” Arthur began. “We’ve always had a good sex life and, frankly, we miss it.”

Expanding on her husband’s comments, Elaine added, “I have to confess—sex isn’t quite as earthshaking an event for me as it is for Arthur. But I enjoy the togetherness, and I’m distressed to see him so hot bcrcd and unhappy for so long a period of time.”

“Then the thought of a reinvigorated sex life doesn’t bother you,” I asked her.

“Oh no. In fact, I would welcome it. And if reinvigoration means what I think it does, then maybe it will do something for me, too,” she answered with a blush.

Reaching over to hold her hand, Arthur told me, “1 have to say that my own expectations aren’t huge—but I owe it to both of us to do what I can.”

This loving pair showed another dimension of a sex life:

• both partners were content with their pre-ED sex lives, but at different degrees of satisfaction

• friendship was the foundation of their relationship

• one had increased expectations, while the other did not

• they were willing to take the time to make the adjustment required

• they didn’t want to keep things the way they were just because it would be simpler that way

For this couple, the pill was much more than erection insurance. They clearly saw its implications for them. They could now build on what they already had. Because their feelings and trust for each other were so strong, the medication held the promise for even greater connectedness. To them, sex was an extension of their love for each other.

*62\183\8*

Although it might take some effort, it is possible to continue enjoying your sex life during and after cancer treatment. There’s this old joke about a man who breaks his fingers and, after he has them straightened and put in splints, asks ‘Doc, will I be able to play the violin?’ To which the doctor replies, ‘Yes, of course you will!’ The patient then says, ‘Wow that’s incredible, I never played before!’ The answer to ‘Will I have a great sex life after my cancer treatment?’ depends largely on how things were before. Major problems in a relationship are not suddenly going to resolve because there is a crisis. They may be put on the backburner for a while, priorities may be reassessed, but they aren’t just going to disappear. That’s where specialized counselling can help.

If a relationship is stable and supportive and there is good communication between partners, they stand a very good chance of things getting back to normal. And of course there are those who never cared much for the violin anyway.

Your sexual routine may need to change, at least for a while, and the key to this is communication. Initially, that means communicating with health advisers so that you know what disruptions to your sexuality there are likely to be, so that you can plan ways of dealing with them. All the while, it is important for partners to communicate with each other. Sometimes that communication has to be more detailed than ever before.

*140\17\9*