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SEXUALITY AND SEXUAL ORIENTATION

An essential part of sexual identity is sexual orientation. Sexual orientation refers to a person’s enduring emotional, romantic, sexual, or affectionate attraction to other persons. You may be primarily attracted to members of the other sex (heterosexual), your same sex (homosexual), or both sexes (bisexual).
Homosexuality refers to emotional and sexual attachment to persons of the same sex. Many homosexuals prefer the use of the terms gay and lesbian to describe their sexual orientations, as these terms go beyond the exclusively sexual connotation of the term homosexual. The term gay can be applied to both men and women, but the term lesbian is applied only to women.
Bisexuality refers to emotional attachment and sexual attraction to members of both sexes. Bisexuals may face great social stigma, as they are often ostracized by homosexuals as well as by heterosexuals. Little research has been done on this segment of the population, and many bisexuals remain hidden or closeted.
Throughout history, the mental health status of gays and lesbians has been debated by scientists and laypersons alike. In 1973 the American Psychiatric Association’s board of trustees unanimously voted that homosexuality was not a mental illness or psychiatric disorder. This position was affirmed by the American Psychological Association and the Board of Directors of the Sexuality Information and Education Council of the United States (SIECUS). Recently, the issue of homosexuality as a treatable “disease” has been resurrected. Therapies labeled as conversion or reparative therapies are being promoted in a series of full-page print ads in national newspapers and in television ads. Mental health professionals have found these ads so troubling that a special resolution was passed by the American Psychological Association reaffirming that homosexuality is not a disease or disorder in need of treatment or a “cure.”
Most researchers today agree that sexual orientation is best understood using a multifactorial model, which incorporates biological, psychological, and socioenvironmental factors. Biological explanations focus on research into genetics, hormones (perinatal and postpubertal), and differences in brain anatomy, while psychological and socioenvironmental explanations examine parent-child interactions, sex roles, and early sexual and interpersonal interactions. Collectively, this growing body of research suggests that the origins of homosexuality, like heterosexuality, are complex. To diminish the complexity of sexual orientation to “a choice” is a clear misrepresentation of current research. Homosexuals do not “choose” their sexual orientation any more than heterosexuals do.
Much of people’s need for “explaining” homosexual needs, feelings, and behaviors arise from a fear of the unknown. In many instances, those fears are irrational. Irrational fear or hatred of homosexuality creates antigay prejudice and is expressed as homophobia. Homophobia in our society is expressed in many ways, subtle and not so subtle. Homophobic behaviors range from avoiding hugging same-sex friends to name-calling and physical attacks. Herek and colleagues surveyed 2,259 gay and lesbian people and found that one in five women and one in four men had been victimized in the preceding 5 years because of their sexual orientation.
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THE MAN AND THE METHOD – CONCLUSION

One can picture a man entering his sexual life and making decisions about contraception. He is prepared by his early sexual and family experiences, and is under a yoke of expectation from both himself and others. He may be able to accept and assimilate such forces, or he may not be able to cope, using such defences as denial, splitting or internalized depression.

In our everyday work with patients, doctors will discover that the aggressive, pleasure-seeking stud is a rare beast, but if they can listen to the hidden feelings, doctors will find a more complex human being. Although he may have times of uncontrolled pleasure, they will be interspersed with upsurges of longing for safety and loving, and the problems brought by the need to be in control.

When in a stable pair bond, decisions about limiting his family will seldom be based on his personal needs alone. He will worry about his partner, and such concern is to be welcomed, but at other times it may be necessary to help him to pay more attention to his own needs. Such necessary concern for the emotional life of both partners may lead to a move from one contraceptive method to another until one is found that feels right.

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THE COUPLE – INTERACTING TOGETHER

Noticing the way in which couples interact together in the clinic or surgery can give an insight into how they interact together at home, and so play an important part in the help that can be offered to them. This type of counselling can be carried out by experienced clinicians at the same time as discussions about the advantages and disadvantages of investigations and treatments. Couples need the opportunity to weigh up their chances of a pregnancy so that they can make an informed choice about the direction to take. Sometimes this involves the painful realization of lost hopes and dreams.

On occasions the two individuals appear to have coalesced into one, in such a way that the wanted baby has become an amalgamation of their mutual desires. Their own individual personalities appear to have been lost many months or even years before. Although they must both have their own emotions and feelings about being childless, it can be very difficult for these to be respected by each other, let alone the doctor.

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AMBIVALENCE ABOUT PREGNANCY – DIFFICULT DECISION

The particular woman’s circumstances, her support network and her own coping mechanisms and ethical framework will influence her decision as to how to proceed with any particular pregnancy.

For some women the factors can be equally balanced, making a decision very difficult.

Mrs C. is a married woman in her late 30s. Her existing children are growing up a little, she enjoys her independence and plans further education for herself. Although she has always liked the idea of another child, this pregnancy was unplanned (she has an IUCD). She loves babies but also values her newly found independence.

Whatever this woman decides will involve loss, either of a baby or of independence and education. Her age means she feels that another opportunity for a baby or for college may not come along. So this to her is a once-and-for-all decision. In the clinic she was initially very angry and critical of the staff. When this was pointed out to her she could see that she was angry at being pregnant and being placed in this position, and critical of herself for even considering abortion when she had a husband and a home.

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THE INJECTION – OUT OF SIGHT, OUT OF MIND – INSTANCE

Marie was brought, kindly but firmly, to the clinic by her health visitor. She was accompanied by four tiny, smiling and scrupulously clean children. Marie lived in a travellers’ encampment, in a small van with her five children, her husband and his elderly mother. Her last pregnancy (a baby left with mother) had been difficult, and she had been advised not to have any more, for a while anyway. And there the problems started. She would not take the Pill, would not even think of the cap and was horrified at the coil. Her husband considered the sheath unmanly, and she agreed with him. Marie was shy, modest and adamant. The doctor began to probe gently, listening to her, rather than educating or teaching. The Pill was bad for the body, everyone knew that. The cap seemed dirty, and rules in the van were strict about cleanliness, even when getting water was difficult. The coil gave heavy menstruation. Marie looked embarrassed but explained there were strict rules about periods and sex, and this would make things difficult. At the moment her husband was, well, not doing anything, but this was not right. He needed to love her, and she him. Hesitantly, the doctor suggested an injectable contraceptive, explained the problems but expected a refusal. Marie was delighted; one injection and then nothing for three months! But how natural! No amount of talk about side-effects could dent her pleasure.

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CONTRACEPTIVE SIGNS OF CONFLICT – USING CONTRACEPTION

There may be a discrepancy between the strength of the patient’s demand for contraception and her reliability in using it. Some women and couples do not use contraception at all, although they could benefit from doing so. They fail to attend either the general practitioner or family planning clinic for advice, but are nevertheless frequent attenders at the surgery for various physical ailments of themselves or their children. Such women or their children are often involved with the social services, and may have children on the non-accidental injury or sexual abuse register. They tend to be labelled as feckless and inadequate, or as ‘poorly motivated’. They form the bulk of the work of a domiciliary family planning service, and some of the insights gained in working with them will be discussed later in this chapter.

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SEXUAL SUCCESS: KEEP THE DIET

There is little doubt that some individuals who change their diet can reduce their cholesterol levels and, over a period of time, even decrease arterial blockages. (Sometimes medication combined with diet is needed.) Canadian doctors, for example, put 50 patients with blockages in their leg arteries on a low-cholesterol, low-fat diet. Some used the American Heart Association’s program, others the Pritikin maintenance plan. Despite their leg pain, all participants were supposed to exercise regularly, cut out smoking as much as possible, reduce their intake of salt and caffeine (both of which can raise blood pressure) and limit alcohol consumption.

After one year on the program, all participants had lower levels of cholesterol and blood fats, and higher levels of highdensity lipoproteins (HDLs), an all-important cholesterol-remover .The researchers also found that the more fiber an individual ate, the more likely he was to have lowered his cholesterol. As an additional benefit, everyone lost weight. All were better able to exercise, as measured on a treadmill. This improvement may reflect increased blood flow to the legs, resulting from fewer blockages in the arteries. Many participants said they felt better. Unfortunately, the researchers did not report the program; effect on erection.

Obesity is bad for your arteries because it promotes in creased fats in your blood, high cholesterol, and keeps you body from producing enough HDLs. And if you are prone to diabetes, overweight will make you more susceptible to it—and the erection difficulties that can follow. So, for heavy men, taking off pounds is a necessary part of any plan for improving the health of the arteries and prolonging potency. A high-fiber diet can help you lose weight, and oat bran in particular may help lower your cholesterol. In addition to limiting your fat intake, exercise is important to losing weight.

Losing weight and keeping faithful to a low-salt, low-fat diet can also help lower your blood pressure. High blood pressure and many medications used to treat it can sap potency. You should have your blood pressure checked at least once a year, more often if possible. Another aid to controlling high blood pressure is exercise.

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REIGNITING YOUR SEX LIFE: TESTOSTERONE RESEARCHES

Research at the St. Louis University School of Medicine has found that giving men an injectable form of testosterone for three months increases their sex drive as well as augments muscle strength. And a study conducted in 1995 at the Chicago Medical School found that a low dose of testosterone given regularly for two years seemed to cause no side effects. According to a researcher involved in the study, the men receiving injections felt better, had denser bones, lower cholesterol readings, and a greater sexual appetite than men who weren’t getting the supplementation.

But, hypogonadism aside, I don’t believe that there is sufficient scientific evidence to warrant testosterone boosting in men with normal levels. If a man is given testosterone supplementation when he really doesn’t need it, his pituitary and hypothalamus—which would normally signal testosterone production—slow down or stop. Once the pituitary gland is suppressed, the testicles begin to atrophy and the man becomes sterile. Another side effect is blood thickening, which can lead to a greater risk of stroke. Extra testosterone can also promote prostate cancer.

If you feel that your libido is drooping, you can raise your testosterone levels naturally. Start a strength-training program that works the muscles of the torso and legs. After a few workouts, there will be a short-term surge of testosterone. This natural boost can be maintained by continued exercise and you will have the added benefit of a stronger body and finer muscle tone. Another factor to consider when evaluating yourself is stress. When pressure starts to rise, testosterone levels begin to fall.

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THE VIRILITY-ENHANCEMENT PROGRAM: THE COENZYME Q EFFECT

A mighty antioxidant with the capacity to help prevent and combat heart disease—and therefore protect the vessels of the penis as well— coenzyme Q (Co-Q-10) is actually present in every cell of the human body. Critical to the conversion of food to energy, it is found more abundantly in some tissue cells than in others. Concentrations of the enzyme are particularly high in the heart, researchers believe, because that organ requires an enormous amount of energy to pump blood throughout the body.

First isolated in this country over forty years ago, the workings of Co-Q-10 are still not fully understood. Animal studies have shown that, by stabilizing cell membranes and keeping them from being destroyed, Co-Q-10 acts as an effective antioxidant that prevents free radicals from attacking and damaging cells.

Various research has revealed that as we age, we lose significant amounts of this enzyme in the heart muscle. In some elderly patients, the levels are as much as 75 percent lower than those of healthy patients. In fact, these diminished levels may be a strong indicator of impending death from heart disease. In one Swedish study, ninety-four hospital patients aged fifty years and older who had died within the prior six months had considerably lower Co-Q-10 than the surviving patients.

Co-Q-10 can also have a dramatic impact on elevated blood pressure. In a study conducted by cardiologist Peter Langsjoen, along with researchers at the University of Texas at Austin, 109 patients with hypertension were administered 225 milligrams of Co-Q-10 every day. After a few months, this quantity significantly lowered the blood pressure of more than half of the test subjects, enabling many to stop taking between one and three blood-pressure drugs.

The patients who showed improvement rallied within four months of daily use. Their systolic (upper number reading) pressure was down, from an average of 159 to 147, as was their diastolic (lower number reading) pressure, from an average of 94 to 85. With the Co-Q-10 supplementation, more than forty of them were able to stop taking one or more of their hypertension medications. Another twenty began using the enzyme alone to manage their conditions.

Remember: 1/you are currently using antihypertensive medication, do not stop taking it. Consult with your physician about starting supplementation of Co-Q-10 in addition to your medicine.

Co-Q-10 is found in small quantities in seafood, eggs, and in all fruits and vegetables. The average person consumes approximately five milligrams of Co-Q-10 daily. Many experts believe that this amount is much too low to meet the needs of the body—especially after the age of fifty. As we age, Co-Q-10 levels begin to drop; by the time we reach middle age, many of us have barely 20 percent of the amount we had in our twenties. This steep drop-off may be due to free radical activity in the mitochondria, the area in the cells where nutrients are converted to fuel for the body’s use.

For men in their forties and fifties 1 recommend daily supplementation of at least 30 milligrams of Co-Q-10. A more accurate dosage recommendation is based on your body weight: 2 milligrams of Co-Q-10 for each kilogram (2.2 pounds) body weight. If you already have heart disease, or risk factors for it, I suggest you take higher dosages after consulting with your physician. Co-Q-10 is available in health food stores and many pharmacies. I find that the softgel, mixed with oil, is more easily absorbed than the dry tablets.

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ERECTILE DYSFUNCTION: SYMPTOM CHECKLIST

Anger, disappointment, sadness, concern, and the urge to help are all appropriate reactions to ED. These feelings apply whether a woman is encountering a male with ED for the first time or whether the condition is within the context of an ongoing relationship. However, when living with his disorder begins to produce disruptive physical and emotional symptoms in her, it’s time for a woman to seek professional help.

A symptom checklist follows. Some of these symptoms may have causes other than your partner’s ED, but are nevertheless having a negative impact on your relationship.

The symptoms are:

? Anger

? Sleep problems

? Fearfulness

? Eating problems

? Stress

? Difficulty concentrating

? Lack of self-esteem

? Feelings of hopelessness

? Troubling thoughts

? Depression

? Anxiety

? Alcohol or drug use

? Problems at work

? Memory loss

? Distractedness

? Health problems

If a woman identifies more than three of the above symptoms in her partner, she should consider seeking professional help. Having a relationship with a man suffering from ED is no easy matter. Talking over the problem, and how it makes her feel, is a big step toward helping herself, as well as her partner.

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