THE VIRILITY SOLUTION: INITIATING CHANGE
It’s never easy to admit that your sexual relationship needs help. Modifying it takes work and time, but knowing those areas that are giving you and your partner trouble will make it easier. Of course, each relationship is unique unto itself, as unique as the two people involved in it. But there are several general points that everyone should keep in mind:
Always Keep the Lines of Communication Open
It’s paramount that you speak frankly with your partner about your condition. You must know whether each of you is supportive. Be honest about your feelings, sexual needs, and desires. If you are both in agreement that treatment is the right course, your partner needs to be part of the process.
Schedule Time for Love
Plan blocks of time, within your regular schedule, when you are both relaxed and comfortable. Recognize that as a man ages, he requires more stimulation in order to become aroused.
Partners who share the goal of regaining sexual function are most likely to succeed. By working with your partner and physician, you have the best chance of regaining complete sexual fulfillment.
Consider the Benefits of Counseling
If you find that you cannot satisfactorily resolve your problems, I urge the two of you to seek additional help. Sexual counseling with a psychiatrist, psychologist, or certified sex therapist can be an effective way to strengthen and deepen a relationship while regaining lost pleasure.
I am always gratified when my patients respond positively to ED medication. But it is even more satisfying when they and their partner are able to address—and solve—any other problems in their relationships.
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SLEEP ERECTIONS
So far we’ve talked about erections which result from arousal when a man is conscious of the sensations and the pleasure. But there’s another type of erection which has important implications for the diagnosis and treatment of erection problems. Researchers have found that men get erections about five to six times a night during sleep, with each episode lasting as long as 25 minutes. These nocturnal events take place when a man is dreaming, but not necessarily because the man is enjoying some particularly arousing X-rated scenarios. In fact, his dreams may have no erotic content at all. So far, scientists can’t explain just why men get erections at night, but some think it’s the body’s way of exercising the erection process.
Waking up with an erection is usually due to waking up in the middle of the dream. Normal sleep erections show that a man’s physical systems are functioning normally. If a man does not get nocturnal erections, his erection problems are probably caused by some physical condition. (Rarely, it can mean that he is not sleeping normally.) If he does get sleep erections but, when awake, cannot be aroused, psychological factors, possibly triggering spasms in the blood vessels supplying the penis, are probably at work. Simple home tests can help determine if a man has sleep erections, and more sophisticated tests are available at sleep laboratories and medical centers.
You don’t need to remember all these fine points of the erection process. And you certainly don’t want to think of them when you’re making love. But understanding the basics of this process can help you avoid sabotaging yourself—and your partner.
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MAKING LOVE: WOMAN-ON-TOP POSITIONS 2
Woman-on-top positions where the woman is sitting up, have several advantages. The woman has full view of her man, and by taking all her weight on herself, she can more actively caress him while adjusting his penile movements to her liking. The man is free to fondle his partner’s freely moving breasts, which are held tantalizingly close to him, and he can see his penis entering her vagina; both sights are very exciting to him.
He uses his hand to caress her bottom and to control the tempo and force of her movements
With all her weight on her knees she can move freely and control the depth and position of her partner’s penis
She can lean back on to his thighs to take some of her weight from his pelvis
1 The woman starts from lying straight on top of her man. She then lifts herself up, and gradually brings her legs forward and bends her knees. Initially, to avoid applying painful pressure on her partner, she will put most of her weight on her arms and knees.
3 Or, she can lean backwards, taking her legs behind and pressing them close to or pushing them away from her partner’s body as she chooses. She even can bring her legs forward, stretching them towards her partner’s shoulders. In this way, she is free to make swaying or rotating movements.
Man
These positions can be very exciting. The man has a full view of both his and his partner’s genitals, and good access to her breasts, and he is free to stimulate her and vice versa.
Woman
In these positions a woman’s breasts and genitals are free to be caressed, and she can most easily control the position and depth of penetration of her partner’s penis.
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SEXUAL AIDS: CREAMS AND LUBRICANTS
The vagina produces a natural lubricating fluid within a few seconds of effective sexual stimulation. This normally makes penetration by the penis easier and pleasurable. However, if a man does not persist with foreplay long enough, the vagina won’t be given the chance to produce lubrication. Some women, too, do not produce enough lubricant and most, at different times in their lives, for instance after childbirth and the menopause, will produce less secretions than usual. At these times, an artificial lubricant may be used, and creams and jellies that are
water-soluble are widely sold. (Take care when using petroleum jelly such as Vaseline, which may irritate the vagina.)
Creams and lubricants come in handy, too, when anal stimulation or intercourse is contemplated, and when manually stimulating your partner. Many men use them during masturbation to ease friction and enhance their pleasure. During massage, too, scented oils or creams can add to the pleasure.
Many women feel pressured not just by society or their partners but also by their own feelings about the presence or absence of lubrication as a sign of arousal. It is comforting to remember that erection of the clitoris and lubrication of the vagina, even erection of the penis, are merely reflexes that do not always accurately reflect our emotional or aroused state. Women can be intensely aroused without being well lubricated, and similarly men can be intensely aroused without an erection. It is an untenable sexist view of things to think that a well-lubricated vagina is solely an opening for an erect penis.
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DISCOVERING A WOMAN’S EROGENOUS ZONES: THE MOST RESPONSIVE SITES
For most women the breasts are highly erotic and play a vital part in sexual excitement. Sucking, nibbling, licking, stroking and gentle squeezing will cause the nipples to become erect, a certain sign of arousal. However, women do differ greatly here in their reactions to stimulation so it’s important to find out what exactly she likes and doesn’t like.
The most highly erogenous area of a woman’s body includes the perineum, an area of skin between the vagina and the anus. If you put your whole hand on this area, with the outer lips of the vagina closed, and press hard or massage, a woman can be aroused extremely quickly because of the dense network of nerve endings.
Both the inner and outer lips of the perineal area are extremely rich in nerve endings also, and are a highly erogenous zone. The inner lips, however, are much more sensitive than the outer ones, especially if stroked along their inner surfaces along the cleft of the vulva. If you press both lips together and firmly massage with your fingers all the sensitive parts of the vulva, high levels of excitement should result. The clitoris is the most sexually sensitive part of a woman’s body, and the easiest part to stimulate if a man can only learn to do it gently and skilfully, without haste. Stimulation of the clitoris with the tip of the erect penis is particularly pleasurable to many women.
As with the mouth, the entrance to the vagina is rich in nerve endings and reacts intensely to all sorts of caresses (the ultimate being from the glans penis), but it can be ecstatic for some women to be caressed there by a man’s lips and his tongue.
The buttocks are another erogenous zone and they are easily stimulated by patting, rubbing or gentle slaps.
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AROUSAL: WHAT MEN LIKE
Bare flesh This is rated very highly by men. Exposed bodies and expressions of a “come hither” variety are extremely arousing to most males.
Make-up Bright red lips are a sexual turn-on, as are other things connected with physical appearance, such as hair style and colour.
Sexually explicit material Men find “girlie” magazines, soft-porn videos and pin-up photos very arousing: they use them to feed their fantasies and to enhance masturbation. The majority of men, however, would not be particularly aroused by their own partner appearing in a girlie magazine; it is the fact that such a woman belongs to somebody else that is part of her attraction.
Sexy clothing Black, lacy underwear and scanty nightclothes are particularly pleasing to most men, hence models posing in suspender belts and stockings.
In terms of the stimuli that excite them, men and women differ markedly. Men, generally, are stimulated by what they see. Women, on the other hand, are very different; as a general rule, they respond very little and very slowly to visual stimuli. Women are more interested in men in the context of their personalities.
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A MAN’S RESPONSE TO SEX: BODILY CHANGES OCCUR
As well as causing the penis to become erect, the increased blood supply leads also to reddening and mottling of the skin in about a quarter of all men. This “sex flush” starts in the lower abdomen and spreads over the skin of the chest, neck and face. It may appear on the shoulders, forearms and thighs and, when fully developed, may even look like measles. Its appearance is always evidence of high levels of sexual excitement. After ejaculation, the sex flush disappears very rapidly.
A man’s breast, like a woman’s breast, is very responsive to sexual stimulation. Though the pattern is inconsistent, nipple swelling and erection, which may develop without direct contact and can last for an hour after ejaculation, occurs frequently. Many women are not aware that a man’s nipples, and even his chest, can become erogenous zones if they are given enough stimulation.
A man’s heart rate increases with sexual excitement, and his respiratory rate and blood pressure also rise. His scrotum thickens and his testes will be drawn closer to his body. Many men sweat involuntarily immediately after ejaculation, but this is not proportional to the amount of physical exertion during intercourse. Sweating is usually confined to the soles of the feet and the palms of the hands but may appear on the trunk, head, face and neck.
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HUMAN PAPILLOMA VIRUS INFECTION (VENEREAL WARTS) – MANAGEMENT
Personal hygiene is important. Affected parts should be kept clean, cool and dry. In females, any associated vaginal discharge should be investigated and treated.
Warts on the skin may be treated by the direct application of podophyllin
(10 to 25% solution in spirit or other solvent). When first used, the podophyllin should be washed away after 2 to 4 hours; if tolerated by the patient, the duration of subsequent applications can be increased. The area surrounding the wart can be protected by applying petroleum jelly before podophyllin is applied. Podophyllin is neurotoxic and large areas should not be treated at one time. Podophyllin should be avoided during pregnancy and must not be applied to the cervix. Treatment can be repeated every 2 or 3 days if necessary. Cauterisation or cryosurgery can be used for small lesions, if necessary under general anaesthetic. Trichloroacetic acid can be used for small keratinised lesions. Larger warts may be excised surgically. Carbon dioxide laser surgery possibly offers the best treatment option for patients with extensive condylomas or condylomas which are resistant to simpler treatments.
Sexual partners of patients with HPV infection should be examined.
Patients and their partners should be counselled about the prevention of transmission of the virus, including the use of condoms.
Because of the association of carcinoma with cervical HPV infection,
annual cervical cytological examination is recommended. Colposcopy is advisable for women with abnormal cervical smears. Because of the possibility of concomitant syphilis, syphilis serology should be repeated after 3 to 6 months.
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GENITAL HERPES – CLINICAL MANIFESTATIONS
The incubation period is usually from 3 to 6 days but may be longer.
In males, primary lesions usually occur on the penile shaft, prepuce or glans or the anal region.
In females, primary lesions occur commonly on the labia, clitoris, introitus and vagina. The cervix is involved in at least 50% of cases. In about 25%, the cervix is the only site of lesions and these cases may be asymptomatic.
Lesions may occur in the mouth or throat following oral sex.
Lesions may occur on the fingers, buttocks, torso and the eyes as a result of autoinoculation. Transmission may also occur on fomites.
Lesions are usually preceded by a 12-24 hour prodromal period characterised by local hypersensitivity or discomfort.
Multiple vesicles appear. They are surrounded by an areola of erythema. After 24 to 72 hours, the vesicles rupture to form painful superficial ulcers. Lesions of varying age and size coexist. Symptoms persist for 1 to 3 weeks. In 75% of cases, regional lymph nodes are enlarged and tender for up to 6 weeks.
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SYPHILIS – DEFINITION
Syphilis is caused by Treponema pallidum, one of a group of closely related spirochaetes including Tpertenue,Tcarateum and Tpallidum var Bosnia which cause yaws, pinta and endemic syphilis respectively.
In Australia, syphilis usually presents either as a primary lesion or through the chance finding of positive syphilis serology. Practitioners should be alert to the various manifestations of secondary syphilis. Congenital syphilis is rare where there is general serological screening of antenatal patients. Tertiary, cardiovascular and central nervous syphilis are rarely seen. Notifications of syphilis have increased in the past decade. This is largely attributed to a high incidence in urban homosexual men.
The usual mode of transmission is sexual intercourse. Transplacental transmission to the foetus can occur. Tpallidum may be spread by blood contamination, for example by needlestick injuries or the sharing of needles by intravenous drug users or by direct contact with open lesions.
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