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WHAT IS THE DIFFERENCE OF STIMULI, TO WHICH MALE AND FEMALE RESPOND?

Husband is excited by his wife’s body while she depends on tactile stimulation alone to get excitement. Thus husband likes to keep the light on but she prefers dark and even closes her eyes so that the sights which are stimuli to husband causes destructions to wife. Darkness may mean for her modesty, secrecy or safety.What is the common complaint of wife against husband?Wife thinks that she is being taken as granted and husband does not give due importance to arouse her showing his selfishness. A wife may want to prolong coitus after orgasm and feel disappointed when her husband turns away and goes to sleep.
What can be the normal frequency of sex?It depends on the couples health, desire, sexual brought up, education and need. No normal limit can be defined. Kinsey in his survey from the age of adolescence to the age of 85 calculated and it came out to be 3 orgasms per week, including masturbation for men.
What is the frequency Of orgasm a woman gets?In the Kinsey sample about a third of the single females between the ages of 16 and 20, 26 and 30, 46 and 50 experienced one orgasm every other week. Among married females between 21 to 25 about one third had one orgasm. More than 5 percent averaged 3 orgasm a week. 20 percent had one orgasm every other week. Between 36 to 40 one of four women had no more than one orgasm every other week.
Does morals permit girls to masturbate?Society has negative feelings about masturbation by girls. If boy can masturbate why not girls. It is not an unusual practice, it does not cause mental deterioration or physical decay but it has certain advantages that girls who mastrubated to orgasm were more likely to enjoy intercourse later in married life. Masturbation to orgasm can also relieve premenstrual tension and dysmenorrhoea.
When woman feels more sexy?
Wife’s sensual interests are somewhat closer to the surface immediately before, during and after menstruation. Second day of menstruation gives a peak to female according to one survey. On second day some pelvic congestion1 still persists and wife gets orgasm with little bit of man’s effort. A second rise of sex desire coincides with ovulation. There is no reason why people should not concentrate on these days to have orgasms satisfactorily.*101\301\2*

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AROUSAL IN THE FEMALE: ENVIRONMENTAL FACTORS

These play an important part in turning on a female, unlike the male who can usually perform anywhere, as long as he is not disturbed. A woman on the other hand is turned on by the right ‘atmosphere’—moonlight, a rainy or cloudy day, soft music, enchanting scenery, the sound of the sea, dancing with her partner or even by a situation of extreme grief or danger, such as bombing during a war. She likes to be protected from danger by the male. Strange as it may seem, the secret desire “of some women is to be raped and they often dream about being sexually molested!CULTURAL CONDITIONING: This shapes the sexuality of a woman. She is usually guided by society mores. If she has lived in a society where free sex is practised, she will indulge in it when she grows up without any pangs of conscience. On the other hand, if she has grown up in a culture where sex is taboo and even touching a male is not permitted before marriage, she may ultimately develop a guilt complex which may affect her arousal.*97\262\8*

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COPING WITH DAILY LIFE IF YOU HAVE A CANCER: YOU AND YOUR FAMILY

Depending on the nature and extent of your cancer and treatment, living with cancer can have a dramatic effect on your family life. You may be less active and therefore less able to participate in your usual family routines, and your wife or partner may feel the strain of trying to cope both emotionally and practically. It will take time for children to adjust too and to understand that you can’t always join in with their activities.

The extent of the effect on your family will obviously depend on how well or unwell you are. For example, if you need someone to be with you more or less constantly (not necessarily because you need constant ‘nursing’ care, but rather in case you need extra help at times during the day or night), then you need to work out ways of managing that. Your family might be able to manage this with occasional help from friends and relatives, but if you feel you need more support, your hospital or GP can put you in touch with organizations such as Marie Curie Cancer Care or Macmillan nurses, which can organize extra care at home. There is no charge to a patient or their family for this specialist nursing care (although many people feel motivated to support their work by means of a charitable donation).

The best ways of coping tend to evolve over time. You all need to be flexible, and to accept that while you want to preserve as much normality as possible, there will be times when plans go awry. Perhaps a planned day out can’t go ahead because you feel too unwell, causing disappointment to your children. You may feel frustrated and even guilty that your cancer is such a dominant factor in your lives. It is hard, and the desire to avoid disappointing others is strong, but looking after yourself has to remain your top priority.

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YOUR REACTIONS TO CANCER: ANGER

It is common to feel anger and rage that cancer has been inflicted on you. You want to shout ‘Why me? What have I done to deserve this?’ while knowing that there is no ‘good’ answer. You can read technical explanations about how cancers develop, or the factors which make us more susceptible but this is not really the point. All you want is for someone to tell you it’s been a ghastly mistake, and that in fact you have a perfectly straightforward and treatable condition.

We were almost too numb to be angry at first, and oddly, what anger we did feel was directed at the small but (to us) significant inadequacies of the health system. There is also the suspicion that if you once let go of your emotions, you’ll never be able to stop and can wave goodbye to any last semblance of control and rational thought. We were trying desperately hard to be calm and sensible although we were at times incredibly frustrated at the apparent lack of action or progress and at our own powerlessness. There was also the sense that everything we’d worked so hard for years to build up was crumbling around us and that our whole future together was disappearing before our eyes.

We generally consider anger to be a negative emotion, but it can have a positive side in helping you to focus your thoughts and energy. You can channel your anger in a constructive way so that

rather than saying, ‘It’s not fair’, you gradually come to think, ‘OK, so I’ve got cancer. I can’t change that but I can fight to cope with it the best way I can.’ When talking about serious illness, and especially cancer, we often use language which we associate with a battle – ‘I’m not going to let this disease beat me’, ‘I’m going to fight this with all my strength’. Cancer becomes the ‘enemy’, to be treated as something which has to be fought with every possible resource. You can draw on your anger to fuel your determination and a more positive frame of mind which will help you to face your cancer and treatment with greater strength.

Inevitably, frustrations can simmer inside you and there will be times when these boil over and your anger is directed at the people you love most. This is rarely because you feel angry with them personally, but because it is natural to express your emotions to those closest to you. If your anger stems from the sudden loss of control over your destiny, from a sense of loss of strength and ‘status’ or a sudden feeling of inadequacy, it can be hard to put these feelings into a coherent explanation – and you may not feel like doing so. However supportive those close to you are, they need some understanding of your anger in order not to feel hurt and shut out. Of course, you won’t feel like entering into lengthy explanations every time you snap at someone, but if communication is good, people will have a basic understanding of why you feel so frustrated and find it easier to offer you the right type of support when you need it.

It can come as a surprise to experience anger at what is intended as kindness by others. For example, acquaintances who have a friend or relation who has been treated for cancer may say to you, ‘I know how you feel. My friend’s friend had cancer, and it was awful.’ It may seem to you that they claim to know exactly what you are going through, having shared a similar experience only second-hand. You may feel enraged because nobody knows exactly what is in your mind except you. Everybody’s experience of cancer is different, and even two cancer patients talking to one another can’t know exactly what is in each other’s mind. Cancer patients are still individuals even if bound by a shared disease! However, we all draw on our own experiences in our conversations, and people will try to sympathize with your situation by remembering how they felt in similar circumstances, either first or second-hand. The comparisons are well meant, even if you feel like shouting at them, ‘You haven’t got a clue what it’s like!’

In a similar vein, there is a fine line between sympathy and patronizing behaviour. You might find that people are more tactile than usual with you and, for example, touch your arm frequently when talking to you. They are probably trying to demonstrate physically their support and sympathy for you, showing that they are close to you – but it can feel very patronizing. Pregnant women sometimes complain that when their pregnancy becomes obvious, even casual acquaintances feel they have some right to touch their ‘bump’, as if it has become public property. This is a similar syndrome, and it’s difficult to avoid without causing offence: you might feel like saying, ‘Please don’t touch me, I’m not a cat’, but at the same time don’t want to convey any sense of rejection.

You can hardly avoid changes in your perspective on life following your diagnosis. What used to cause your blood to boil with anger and frustration may seem irrelevant now and people who moan endlessly about their seemingly trivial problems can become a further source of irritation to you. A friend who complains of toothache or of standing in the supermarket queue for ages or the breakdown of their car may leave you feeling, T wish I had your problems’ or “Think yourself lucky!’ It is difficult not to voice these thoughts or to be angry with others for taking for granted aspects of life which are currently beyond your reach. Your sense of perspective and outlook on life have taken a battering. In the meantime it is helpful if others take account of this, but life is not that simple and you will need your reserves of patience.

Some men find that anger, whether a brief but violent outburst or a simmering, seething frustration, is expressed in unexpected and uncharacteristic ways. You may be more prone than usual to sudden outbursts or a tendency to snap unreasonably for little or no reason. You may feel a need to exert your authority more than usual, to ‘prove’ that you are still the same strong, capable man, to insist that things are done ‘your’ way, or become more defensive about your role and abilities. The temptation may be strong to reject ungraciously and crossly offers of help with a task which is traditionally ‘yours’, such as walking the dog or cutting the grass.

If you are usually mild-mannered and even-tempered, experiencing anger and frustration from a variety of sources may come as a shock, both to you and your family. This is not a reason to suppress it as ‘inappropriate’ behaviour. You are allowed to be angry, and without feeling guilty or the need to apologize afterwards.

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DEALING WITH YOUR MEDICAL TEAM: THE EARLY STAGES

Most people are referred by their GP to their local hospital to carry out the first stages of investigation and diagnosis. You will probably be given the results of your tests by the specialist who examined you at the hospital. Even if you had suspected that your health problem was serious, a diagnosis of cancer still comes as a tremendous shock, and you will need time to absorb the medical details which are related to you. Everybody’s experience is different so Neil’s is not necessarily typical, although the sense of shock is shared by most.

I am afraid that there is really no way around that dreadful moment when the C-word is first used, and I am not convinced that there is a ‘best’ way in which it can be handled. I had been urgently referred to our nearest Accident & Emergency unit, but neither my partner nor I really had any idea why we were driving some 15 miles to hospital, having no inkling of the nature of the problem or its implications. We spent hours waiting in a side room while the house officer on duty tried to find time to diagnose me between more urgent calls.

Much later, it happened. A surgeon came in to examine me, felt my abdomen and testicles and announced without preamble, “I think it’s testicular cancer.’ He looked at our shocked faces and informed us, ‘Well, you wouldn’t have wanted it told to you any other way, would you?’ Like the first moment when a wave knocks you off your feet as a toddler at the seaside and you swallow a mouthful of seawater and struggle in panic to breathe again, this is a defining moment. The only question I could think of asking was ‘How long?’

‘With treatment, maybe a year or two. Without treatment, about six months.’ And that was that. Diagnosis complete. Neither of us had a clue how to face this.

The next few hours passed in a blur of X-rays and ultrasound scans which confirmed the surgeon’s diagnosis. We then left the hospital, with appointments for a CT scan the following afternoon and an operation to remove the testicle and primary tumour a few days later, but without the painkillers I had been promised.

It was several weeks later that a different consultant at a different hospital gave us the relatively joyous news that he put my chances of a complete recovery at about 50:50. This was a different picture altogether, and gave us something more tangible to hold onto and fight for now.

However sensitively and carefully you are told the news about your cancer, you will probably be aware only of an immense, almost physical sense of shock. How much information you subsequently take in during your consultation is bound to be limited, but even at this stage it is important to try to understand what your doctors tell you. This may sound harsh as it can be difficult to interpret what doctors are saying, even if they are clear in their information from a medical point of view. For example, if you are told that an X-ray or scan shows a shadow or lesions, or that a blood test shows abnormal levels of proteins or hormones or that you are anaemic, this may not necessarily mean much to you as a lay-person, and especially in terms of your cancer diagnosis. You are unlikely to feel like taking charge of the consultation and asking probing questions in scientific terms. Most of us do not have the medical background to be able to do so, and in these circumstances you may well not be capable of your usual rational thought processes.

Becoming accustomed to medical jargon is one hurdle to be crossed. You can’t be expected to be familiar with much of the terminology you hear, and it can feel as if you are being blinded with science. Asking for terms to be explained is essential because those same terms are likely to arise again and again. Bear in mind too that while you may feel frustrated at your need to say – yet again -’Could you just explain exactly what that means, please?’, doctors need to be precise and accurate in the information they give you and hence need to draw on the appropriate precise and accurate medical terms. It would be even more frustrating simply to be told, ‘There’s something a bit odd going on in your stomach/chest/blood.’ A glossary of the terms you are most likely to encounter is included at the end of the book.

Although it can feel like hard work, do try to make sure you have a basic understanding of what you have been told, so that you are not left wondering later if you have remembered correctly. If you attend the consultation alone, you might even try to make a few written notes of the main points and check with your doctor that these are accurate. This approach does not suit everybody, but is a useful habit if you can manage it. If you have a member of your family or a close friend with you and you are happy for them to sit in on your consultation, then they can help by playing a ‘listening’ role for you or by taking notes. At some hospitals it is possible to make a tape recording of your out-patient consultations with doctors which you can play back later.

The process of communication at this early stage is critical, and has to work both ways: not only do you need to understand what you are told, but you need to be able to describe to your doctor how you are feeling. This might include both general and specific points such as:

how you feel generally – basically well, or run down, or suffering weight loss, etc;

your specific physical symptoms – cough, headache, digestive problems, difficulties with mobility, lumps in or on the skin, etc;

whether you have any pain, where it is and what type it is (occasional, constant, stabbing, dull, etc).

If you have previously visited your doctor’s surgery only rarely, it can be difficult to find the right words to describe how you are feeling and it can be tempting to leave out information because it seems trivial or because you feel embarrassed. It can be equally tempting to overstate your symptoms or problems to ensure that they are not overlooked, but this is more likely to cause confusion – if you have an occasional pain, try not to give the impression that it is continuous and unbearable! Don’t worry that you can’t use medical terms: it is more important that you are clear, accurate and as factual as possible in your account and that your doctor has an adequate picture of your problems.

Doctors should always ask you if you have any questions, and at this early stage it can be difficult to formulate exactly what you want to know, when you are still feeling the effects of the initial shock. If you do have specific concerns – especially if you are experiencing any pain – then it is important that these are addressed, and that you feel that you are being listened to. Going home without asking the one key question which has been bothering you for a fortnight will only cause you additional stress in the days to come. You certainly should not feel that the doctors are too busy to spend time answering your questions. They have many demands on their time, but they do want to offer you the maximum possible help and they cannot do this to the full if you feel afraid to discuss your concerns and queries with them.

You may be offered information in the form of leaflets to read at your leisure or the opportunity to talk to a specially trained nurse about your cancer. Your GP will also be kept informed about your diagnosis, and may be able to offer support or details of organizations which can provide you with more detailed information about your cancer. If you are not offered any help of this type and you feel it would benefit you, then do ask. All hospitals should at the very least be able to help you to find written information even if they cannot provide it themselves.

You may well need further tests before your treatment can begin, and the timescale will depend on your hospital and the nature of your cancer. In some cases, a delay of several weeks may be of little consequence and in others it will be necessary to act more quickly. The doctors looking after you should ensure that you receive your care at an appropriate time, but if you feel that delays are occurring for no good reason, then do not be afraid to mention this. You may find that there is a valid reason why tests are not scheduled immediately or your next consultation will not take place for a fortnight. Perhaps test samples have to be sent away to another lab for investigation, for example.

Time can easily become a big issue, especially in retrospect. From a doctor’s viewpoint, apparent delays are likely to stem from one of two reasons. First, there is a medical need to be sure that the diagnosis is correct. One oncologist commented that most doctors can think of little worse from a patient’s point of view than being told erroneously, ‘You have cancer’ and then, later, ‘No, it’s all right. Just a mistake. You don’t.’ Secondly, even after the initial diagnosis has been made, it is still incomplete from a medical viewpoint. For example, different types and extents of cancer need different treatments (there are several types of lung cancer, bladder cancer and testicular cancer, to name just a few), and further tests may therefore be necessary to define the exact type or extent. If you understand these reasons, you will have one less worry in the meantime. With the benefit of hindsight, Neil felt he might have avoided a very distressing week by asking more questions.

After the surgical removal of my testicle, there was a terrible period of 12 days before I was admitted to a specialist cancer unit as an emergency. In retrospect, we did not make anywhere near enough noise to try to force the issue during that time. But we were still deeply in shock, trying to find out more about this cancer and desperately trying to keep on top of the practical details of our lives. While it was quite obvious to me that I was deteriorating rapidly, we assumed that the medical profession knew best, and if they said ‘Wait at home’, then we would wait at home. Although we were trying to be sensible and co-operative, to the extent of making written notes about my particular problems, when we did have a hospital consultation the week after my operation nobody wanted to listen to us. The details of my diagnosis (whether my testicular cancer was of the seminoma or teratoma type) were not yet available, and therefore I did not appear to exist as a cancer patient.

A further week later, I attended a cancer clinic at the hospital. The details of my diagnosis were confirmed, and at last a cancer specialist was listening to me. I was in constant pain and could no longer eat at all. She examined me briefly, arranged for X-rays to be taken and arranged for me to be admitted to the cancer unit of a hospital some 30 miles away, as an emergency patient.

The point of relating this experience is not to heap criticism on the medical profession – although a little more support would have made a huge difference. What is more important is to know when to make a fuss, and not to be afraid to do it. Consultations can be brought forward, stronger pain-killers can be provided – it is not asking too much. Unfortunately, you may only develop the confidence to stand up and make your views known much later.

It is likely that you will see more than one doctor during the testing and diagnostic process. You may feel that you undergo the same physical examination and description of your symptoms and history over and over again. This can feel frustrating, and it helps if you understand the role of the various different doctors in your care. For example, you may see a specialist in treating the part of the body in question (Such as a urologist or a chest specialist) and also an oncologist (a cancer specialist). Indeed, you may see several doctors at different levels of seniority from each of these departments, and it can take some time to work out where they fit into the hospital hierarchy. They should always introduce themselves to you, but again, do not be afraid to ask them about their role in your care: they may be involved only in your diagnosis, for example, or in a longer term role in the treatment of your cancer. They may be instrumental in reaching decisions about your diagnosis and treatment, or they may have a more junior role.

One vitally important issue your doctors should address early on is the potential need for sperm collection and banking. If they do not, then you should not feel shy to bring up the subject yourself: it is too important an issue to be passed over. Some chemotherapy drugs and radiotherapy treatments can affect your fertility and if you have not yet had children or feel that you may wish to have more children in the future, then you may need to consider sperm banking. This should be discussed with you at an early stage if it is appropriate: once treatment is underway, then it may be too late. In some cases, fertility may gradually return after treatment is completed, but sperm banking will act as an insurance policy if this is not the case. This is a difficult and emotive issue, particularly for relatively young men who had assumed that they would one day father children without the need for medical intervention, and you may find it difficult to discuss with relative strangers. It may also be that you already feel saturated with bad news and would rather not face yet another problematic issue. Do try to talk about it, not just with your doctors but also with your spouse or partner and remember that it may be an extremely valuable insurance policy in years to come.

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CANCER TREATMENTS: SURGERY

Why is surgery needed?

Surgery remains an important element in the treatment of many cancers and it may be proposed for several reasons:

to remove the primary tumour entirely and thereby establish a diagnosis;

to remove as much cancerous tissue as possible before proceeding to other forms of treatment;

to alleviate symptoms or the effects of your cancer, such as a bowel obstruction, even if surgery is not the main form of treatment.

There are some types of cancer such as leukaemias and lymphomas for which surgery is not appropriate because the cancer is, by definition, not restricted to a localized and operable site in the body.

While surgery may be helpful in many cases, there are circumstances where an operation is not a practical option. This may be because it is felt that the risk to you as the patient would be too great or because it would not be possible to remove enough of the tumour to make surgery the most effective treatment at this stage. This might be the case if your cancer has already spread, making cure by surgery alone impossible, while the lump itself is not causing you problems. It does not necessarily mean that surgery is completely ruled out later, but rather that alternative forms of treatment are felt to be more appropriate at this stage. It is worth reiterating that your doctors will propose the treatment which they feel is likely to be most effective for your particular circumstances.

What will surgery entail?

If the cancer is confined to a localized site, it may be possible to remove the diseased tissue surgically, together with part or all of the affected body organ. If the cancer has spread to other sites in the body, then it is more likely that either surgery will not be recommended at all, with the focus on treating the whole body, or the surgery will be designed to remove the primary tumour (the ‘source’ of the cancer) before using other forms of therapy to treat the secondary cancer. In all cases, the decision to operate will depend upon where your cancer is situated and whether your oncologist and surgeon feel it is safe and reasonable to operate on it. Before surgery goes ahead, tests and scans will be carried out to build up as detailed a picture as possible about your cancer, but it is obviously not possible for a surgeon to assess exactly what will be found once the operation is underway.

Some forms of surgery are obviously more complex and invasive than others: an operation for melanoma (skin cancer) differs greatly from surgery for cancer of the bowel. It is therefore very important to discuss your operation in advance, and to be clear about the possible implications. By definition, surgery involves some degree of physical damage to the body. This may be limited to an inconspicuous scar which will fade in time and cause no long-term distress, but in some cases the damage will be more severe. There may be more obvious physical impairment, which can be difficult to accept at first, such as the removal of a testicle in cases of testicular cancer. We are all concerned to some degree by physical appearances, and if your operation will necessarily cause some change to the appearance or behaviour of your body then it is important to understand this in advance. For example, it may be possible to insert a prosthesis in cases where a testicle has been removed. Sometimes the consequences of surgery will have a more far-reaching effect on your life.

For example, one of the possible outcomes of surgery for certain types of cancer, where part of the bowel or bladder is removed, is that the body can no longer deal with its waste products in the normal way, either temporarily or permanently. To allow the body to get rid of its waste, the surgeon has to create a ‘stoma’, a small opening on the surface of the abdomen. There are three types of stoma:

a colostomy is a stoma in the large bowel (colon);

an ileostomy is a stoma in part of the small bowel (ileum);

a urostomy is a stoma in the urinary system.

A stoma is created during the operation. The surgeon will bring a healthy part of your colon, ileum or urinary system to the new opening on the surface of the skin. A bag is attached to the opening into which the bowel or bladder contents can pass.

This procedure will only be necessary in certain specific cases. However, if there is a possibility that it is needed, it is very important to discuss it in advance so that you have the opportunity to prepare yourself for its effects. The prospect of living with a stoma can be distressing at first, but the majority of stoma patients can manage to adapt so that their lives are as near normal as possible. You will be taught how to empty and look after your bag, so that it becomes a normal part of your daily routine. A stoma nurse will be able to talk to you about your stoma and advise you about, for example, dietary considerations or any fears you may have about its effect on your life and how you can best cope.

If your operation will have specific effects on your life in the future, you may need extra support and information about how best to adapt and cope. The medical team attached to the ward where you have your surgery will be experienced in helping patients come to terms with these changes, and it makes sense to draw on their knowledge and expertise and to ask them how other people cope best. Many specialist wards also keep a range of leaflets dealing with the particular issues their patients are likely to face. If these are not obviously available then do ask, or approach your GP if you prefer.

Are there any alternatives to surgery?

The very nature of surgery can make it a frightening prospect, and you may wonder whether less invasive alternatives exist to treat your cancer. This is very much a matter for consideration on a case by case basis, and should be discussed with your team of doctors. Surgery will not be recommended without good and specific reasons. If alternative treatments are available for your type of cancer, then these will be explained to you and the relative chances of a successful outcome assessed. The final choice to have surgery or not will always be yours, but based on as much information as you wish to be given.

Coping with surgery

Before you undergo surgery, it is important to understand not only the physical nature of the operation, but also its more general effects. You may need to make arrangements for extra support and care while you are convalescing, for example, or to let your employer know for how long you may be unable to work. It can be useful to prepare a list of questions to ask the surgeon when you meet him or her and to have a member of your family or a close friend with you for extra support. The idea of a list of questions may seem over-formal, but it is very easy to forget issues which are important to you when you are feeling worried and possibly very unwell. They might include:

How long will I be in hospital? This will depend both on the type of operation and on your own physical state: a young, basically fit young man may recover more quickly than someone older and in less good general health.

How long will I be convalescent? Again, this varies between individuals, but you will cope more easily and be in a better position to make appropriate arrangements if you know that you will need more help and support than usual for, say, a week or a fortnight or a month.

How much pain or discomfort should I expect, and what sort of pain relief will be provided?

What can I expect when I wake after the operation?

How much scarring will there be?

What other physical effects can I expect?

Will there be any impairment of my sexual function?

What sort of post-operative follow-up will there be? (check-up by your surgeon, further tests, X-rays or scans, etc). How soon?

What will happen next? (additional chemotherapy or radiotherapy treatment, monitoring, etc).

Who will perform the operation?

Surgery is necessarily an invasive procedure and it is natural to have qualms about agreeing to an operation. If you are as well-prepared for it as possible by talking it over beforehand, then you are likely to find its effects easier to cope with afterwards.

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CANCER

One of the keys to coping with any difficult situation is to have sufficient information and knowledge of the facts to enable you to understand what you are facing and to make reasonably well-informed decisions. The first problem for most men when faced with a diagnosis of cancer is a very sketchy knowledge of what cancer is. Even if you have had previous contact with someone who has been treated for cancer, there is a high chance that you knew only a little about their condition. Knowledge is very important, because it gives you the power to take a more active role in the management of your disease – if you want to.

How much you decide to find out about your cancer is entirely dependent on you. Some people like to be told or read quite detailed technical information about their cancer. Others prefer to know only as much as they are told by their doctors and oncologists (specialist cancer doctors) and choose not to ask for more indepth information. In any case, a basic understanding of how cancer develops and some detail about your own cancer in particular will be of benefit to you and those close to you, if not at the beginning of your journey through treatment, then almost certainly later on.

This chapter looks at cancer in two ways:

General information about how cancer develops

Information about specific cancers.

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ARE YOU SUITED FOR SEX THERAPY?

A good candidate for sex therapy is someone interested in finding out more about himself. Therefore, he is somewhat intro- spective, has some insight into himself and wants to learn more. He will have functioned well sexually in the past, and his problem will have developed recently. This is particularly important, because men with erection problems may become extremely depressed, and solving the problem early can help men avoid the cycle of rejection and despair that can develop overtime.

Some therapists require that a man with an erection problem already have a partner in a relationship. The reason for such a rule is that because sex is something which concerns both partners, both should participate in any resolution of a sexual problem. The two partners don’t have to be married or to have been together for a long time, but it’s important that they feel good about each other. Other therapists will work with men who do not have a steady partner, or don’t have a partner at all.

Perhaps most important of all, a good candidate for sex therapy is someone who is motivated: He wants to improve his sexual functioning and his sexual relationship and learn more about his body. He is willing to do the homework the therapist assigns; he wants to change.

There are also key characteristics a good candidate does not have. He doesn’t suffer from persistent, long-term, low sexual desire, even though the erection problem may have recently reduced his interest in sex. He’s not seeking help just because he’s being pressured to change by his lover. He doesn’t have very restricted and firmly fixed ideas about what is “normal” sex; he will consider sexual behavior besides intercourse, and he’s willing to experiment. He does not carry within him a strong prohibition against sex. For example, a man who says, “I avoid sex until I can’t stand it” will need to spend additional time in sex therapy examining and reconsidering his attitudes.

Along the same lines, someone who remarks, “I masturbate only when I can’t stop myself” isn’t going to be comfortable stimulating himself as part of a sex therapy program. Working on his attitudes toward self-pleasure would be an important first step, and a good sex therapist would be able to help him examine and possibly change those feelings.

Just as the wife or lover plays an important role in diagnosis and treatment, she can be crucial to successful sex therapy. In the best situation, the partner is interested, involved and sup- is that you and your partner honestly share your feelings and concerns with the therapist.

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POTENCY: CHECKING OUT THE VEINS

Until very recently, most doctors thought that veins, which carry blood out of the penis, weren’t important culprits in erection problems. Doctors thought that the amount of blood leaving the penis didn’t change much, whether a man was erect or not. The arteries were the main concern. The fact that some veins in the penis could be abnormal and sabotage erection all by themselves wasn’t recognized.

That view has undergone a radical shift in just the last few years. New research has demonstrated that abnormal veins in the penis can sabotage erection. They do this by letting blood flow too rapidly out of the penis, thus preventing a man from getting or maintaining an erection. Normally, when a man becomes erect, the veins partially shut down, restricting the blood flow. Leaky veins, however, don’t get the message, and keep the blood flowing out of the penis.

In fact, some experts now think that a significant percentage of men with physically caused erection problems may have leaky veins. Doctors are continuing to study the problem and new research should soon tell us even more.

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CONTROL YOUR EJACULATION: BUILD THOSE MUSCLES

You know that the penis itself contains no muscles, but exercise still might be able to help your sex life. We’re not sure exercise helps, but some sex therapists suggest that Kegel exercises to strengthen the pelvic muscles may help you prolong intercourse. (Kegel exercises have for years been recommended to women who want to increase their sexual enjoyment.)

In order to exercise the pelvic muscles you first have to find them. There are two ways to do this, according to sex therapist-Bernie Zilbergeld, Ph.D., the author of Mate Sexuality. You can pretend you are holding in a bowel movement; the muscles you squeeze are the pelvic ones. Or, when you are urinating, stop and start your flow several times; when you stop the flow, you’re squeezing the muscles you want.

Once you know where the muscles are, you can try squeezing and relaxing the muscles 10 to 15 times, twice a day. Dr. Zilbergeld suggests you gradually increase your workout to 60 or 70, twice a day. And once you’ve mastered that, you can try holding the squeeze for a bit longer and then relaxing. However, it’s important not to overdo it and to increase gradually, because, as with any exercise, too much too soon can make you sore.

Some therapists say that strengthening these muscles can help you last longer and control your ejaculations more easily. If you tighten these muscles just before you ejaculate, you’re doing a kind of internal squeeze technique.

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