Archive for the ‘Men’s Health-Erectile Dysfunction’ Category

ANALYSIS OF THE FAMILY PLANNING CONSULTATION – SELF-MONITORING

Tuesday, April 7th, 2009

This process takes place continuously while a doctor is consulting but needs to be practised for full advantage to be gained. There are two elements. First, recognition of the feelings in the doctor engendered by the patient may help him or her to understand the patient’s problems, particularly if a problem involves a relationship with another person. In Chapter 1, Elphis Christopher describes beautifully how the process of becoming entangled with the patient’s problem allows feelings in the doctor to surface. Freeling and Harris (1984) categorize the doctor’s feelings into those that are unconnected, indirecdy connected and direcdy connected. Unconnected feelings can arise from the doctor’s own domestic problems or from an emotion aroused by the last patient seen. Indirectly connected feelings may arise when the doctor identifies a problem he or she has experienced, such as a marital or sexual difficulty. Both of these categories of feeling lie strictly in the domain of the doctor’s personal life. Directly connected feelings may be used legitimately in the consultation. Training in psychosexual medicine helps doctors to appreciate when it may be appropriate to feed these back to the patient. However, this must be done carefully and sensitively. This skill is an intuitive one which is a far cry from the conventional history-taking type of consultation that many doctors were taught at medical school.

*351/197/1*

PSYCHOSEXUAL PROBLEMS IN THE CONTRACEPTIVE CONSULTATION – RELATIONSHIP PROBLEMS (INSTANCE)

Tuesday, April 7th, 2009

Miss L. was an attractive 18-year-old. She had come to have a coil fitted. The doctor asked why she wanted to change her method. She stuck her jaw forward and said that she had been on the Pill for two years and had gone off sex. She was sure it was the Pill and wanted a coil instead. She looked away from the doctor, not wanting any more discussion (or perhaps to avoid persuasion that this was not the right choice). The doctor waited but no more was forthcoming. ‘Tell me a bit more about when you first noticed you were going off sex,’ she prompted. With lots of ‘urns’ and encouraging nods from the doctor, Miss L. hesitantly told her story. She had known her boyfriend since she was 15, and she thought it was time that they got engaged but he did not want to commit himself. As she told the doctor about keeping her evenings free for him and how he then went out with his mates instead, her anger became evident. The doctor picked this up and used it to show her how dissatisfied she was. As they talked. Miss L. gradually realized that she could not change her young man’s behaviour and became thoughtful. She decided to postpone having a coil fitted. The next time she was seen, for an unrelated problem, the doctor noticed that she must have run out of Pills and asked her about it. Miss L. explained that she had stopped taking the Pill. ‘We had a big bust up. I started playing badminton with a girl from work and was out one night when he wanted to see me. I told him he didn’t own me and some other home truths about how selfish he was – he didn’t like it at all and I haven’t seen him for weeks now. Good riddance, is what I say!’ and she flashed a smile as she went out.

*312/197/1*

CONTRACEPTIVE CARE OF THE OLDER PATIENT – AGE AND SEXUAL FEELINGS (COUNSELLING)

Tuesday, April 7th, 2009

The acceptance of the patient’s sexuality is as important as prescribing the right method. A nonjudgemental acceptance and a willingness to allow the patient to explore any feelings of guilt, embarrassment and sometimes even shame is as important as the provision of postcoital contraception. It is important that such feelings are dealt with when they are offered, for if left unresolved they can be very destructive. Such help need not be time consuming and it can prevent subsequent problems in sexual health and relationships which are a potent source of ill health (Sims, 1992).

Younger doctors and nurses may feel uncomfortable when patients old enough to be their parents need help with sexual matters. With experience they will notice that only with some patients do they feel embarrassment, and such a feeling is usually a response to patients who have some feeling within themselves about their age and sex. Indeed, some people may choose, either consciously or unconsciously, to consult someone whom they perceive to belong to a generation that knows about sex and will not be easily shocked.

Contraceptive and sexual problems at this age may be a symptom of difficulty in adjusting to the inevitable changes in role and pattern of life.

*274/197/1*

CULTURAL PERCEPTIONS AND MISCONCEPTIONS – CULTURE AS AN ISSUE FOR THE PATIENT (CONCLUSION)

Tuesday, April 7th, 2009

Forida Akhtar, a 35-year-old Sylheti woman, complained of pains in her back and shoulder. No diagnosis could be made from routine clinical assessment and over a matter of weeks she became more and more uncomfortable with the pain, finally volunteering that it was, in her view caused by her coil. Her husband who was sympathetic and attentive, readily concurred, and although the doctor felt that the pain could be psychosomatic, she was not confident that the IUCD was the cause of the problem. With little room to negotiate, the progestogen-only Pill was prescribed while the couple received instruction in barrier methods, their preferred choice once the coil was removed. Once released from the necessity of putting up with the coil, the couple revealed that they had never felt that the coil was allowed by their religion, and were relieved to be able to do without it. The initial choice of a coil had been made mostly on medical grounds.

As in so many aspects of their lives, newcomers to the West are in a state of flux, and fall somewhere between the traditions of their homeland and the current mores of the UK. If nurses and doctors are sensitive to the changes that are taking place, often very quickly, the patient can use them as facilitators, and thus find their own position in their particular cultural and social context. For a couple who previously believed that all children should be accepted, and that no contraception should ever be used, the experience of one years’ infertilty on the basis of postponing the next pregnancy rather than limiting the family can be profound. The essential part of the learning process is that their experience of infertility is achieved with contraception rather than by geographical separation.

*236/197/1*

THE SEXUAL NEEDS OF PEOPLE WITH DISABILITIES – EMOTIONAL NEEDS (INSTANCE)

Tuesday, April 7th, 2009

Jean Jones has a physical disability and some degree of mental handicap. She would love a normal relationship that would end in marriage and possibly children. She lacks confidence. At the first sign of any interest shown in her she pours her loving feelings upon the prospective partner and her demands and expectations overwhelm him and he takes fright and disappears. It has been necessary to explore this pattern of behaviour with her so that she can share her feelings and understand what is happening. She has begun to feel that it is acceptable to need, to want and to have relationships, and it has been possible to begin to explore her underlying anxieties. She is beginning to gain some insight into her desperate need to grab hold of a new partner lest this be the last opportunity, for such opportunities are indeed rare for her. There is still much work that needs to be done with this patient if she is to have a chance of finding a fulfilling relationship.

*198/197/1*

COPARTNERS IN THE OFFENSE: HOMOSEXUAL OFFENSES

Monday, March 30th, 2009

Vs. minors

A sixteen-year-old male and three friends were swimming nude and saw a fourteen-year-old boy on the opposite bank fellate a fifteen-year-old boy. The parties joined forces and finally all males were fellated by the youth. There was some horseplay, but the extent of force was questionable.

Vs. adults

A homosexual party at the twenty-nine-year-old offender’s home led to heavy drinking and excessive noise. Neighbors complained and the four men and the host were arrested. It was claimed by the offender that there was no overt sexual behavior prior to the arrest. Thus, four of the cases involved three copartners, three of them included four males in addition to the offender, and there was one offense in each of the highest categories of five, six, and seven copartners. The ten accounts given above do not appear, however, to portray generally planned behavior. On the contrary, one feels it to be very much a matter of chance and accident that the particular situation built up. The offenses are typified by the picture of young, aimless males driving around in a car, with an eye out for a potentially willing female if they can find one. A lone male of these ages might well have lacked confidence to attempt a pickup and a sexual approach, but numbers often breed a sense of courage. It will be noted that in these ten cases of group behavior the young offender is in strong evidence. This is understandable, since such group social patterns are typical of younger males.

In fact, if one records the ages of the 92 males at the time they committed the offenses involving copartners, and compares their median age with that of the remaining males at the time of their offenses, it is clear that the offenders who operate in pairs or in larger units are consistently younger than the other offenders in their group. This is no real surprise, since studies of nonsex offenses tabulated on the basis of age and multiparticipation show the same trend, but it is of interest to find here a consistent pattern.

In summary, coparticipation in sex offenses is atypical, and when present it is most likely to be found in heterosexual offenses committed by younger males. It is rarely present in our sample of homosexual or incest offenses.

*374\161\2*

SEXUAL AROUSAL FROM SEEING OR THINKING OF FEMALES

Monday, March 30th, 2009

Since there is among males a very high correlation between arousal from seeing females and arousal from thinking of them, we have combined the answers to these two questions. The variation in response is great: at one extreme are the incest offenders vs. children and the control group, very few of whom (4 and 10 per cent respectively) reported little or no response, while at the other extreme are the heterosexual offenders vs. adults (41 per cent) and the homosexual offenders vs. adults (35 per cent). The fact that the heterosexual offenders vs. adults have the largest percentage of persons reporting little or no arousal from thinking of or seeing females, and the heterosexual offenders vs. minors have the third largest percentage (31 per cent) may at first seem paradoxical, but is simply explained. Persons with high frequencies of heterosexual coitus are relatively sated and hence respond to heterosexual stimuli less intensely. In addition to being heterosexually quite active, the majority of men in these two offender groups were interviewed very early in the history of the research, when these questions were dealt with rather summarily and no cognizance was taken of anything other than current status. No more than half of any other group were interviewed in this early phase. Also, and more importantly, these two groups rank first and fourth in the proportion of persons rated as feeble-minded or with below-average intelligence. Dullness correlates with lack of response to noncontact stimuli. Among the six groups with fewest individuals reporting little or no response are the three aggressor groups, whose members could scarcely have been moved to commit their offenses without some visual or imaginative arousal, and the control-group individuals who probably owe their position to a combination of relative sexual deprivation and better education, these two factors being generally associated.

Turning to the other extreme—the category of strong and/or frequent response—we find, as we expected, that the peepers lead with 38 per cent. At first glance the rest of the percentages seem rather meaningless, but in actuality die groups occupying both ends of the range do so for known reasons. The high end of the range (37-38 per cent) is occupied by our three youngest groups: peepers, prison, and aggressors vs. minors. Youth, intensity, and frequency of response we know to be highly correlated. The only other group in this range is the control group whose members we have just described as relatively well-educated (i.e., more imaginative) and sexually deprived. At the other end of the range, with less than one fifth of their members reporting strong arousal, we find at the bottom our oldest and second oldest groups, third from the bottom our most homosexual group, and fourth from the bottom the sated (or even burned-out) heterosexual offenders vs. adults. In brief, strong responses to heterosexual noncontact stimuli are positively correlated with youthfulness, sexual deprivation, and higher education and are negatively correlated with old age, homosexuality, and satiation.

*336\161\2*

PREMARITAL COITUS: PROPORTION OF TOTAL OUTLET

Monday, March 30th, 2009

Premarital coitus with companions constituted a substantial proportion of the total sexual outlet for the members of most groups, but reached or exceeded the 50 per cent level among only three, namely, the heterosexual offenders vs. minors and adults and the prison group.

In most groups the proportion tended to increase with age into the thirties, but this is not true of the homosexual offenders, whose percentages are remarkably stable (from sixteen to thirty) and relatively small. The control group and the prison group both attain their largest proportions between twenty-six and thirty, after which a decrease is noted. This decrease seems the result of various combined factors, the first of which is that after thirty the confirmed bachelors tend to avoid emotional entanglements and rely somewhat more heavily on prostitutes for their sexual needs. This seems the case with the heterosexual-offender groups, the aggressors vs. adults, and the exhibitionists. Secondly, with increasing age the still unmarried males contain an increasingly higher percentage of persons with homosexual interest, which obviously tends to reduce the importance of coitus. This is the case with all three homosexual-offender groups. The two control groups show both forms of selectivity operating, with prostitution being the more important.

The proportion of total outlet found in premarital coitus with prostitutes is trivial during the early teens (1 per cent or less) and increases slowly thereafter. The control and prison groups demonstrate this trend best since their numerical size permits meaningful calculations into the fifth decade of life: in their late twenties the members of these two groups were having about 1 orgasm in 10 with a paid female partner; in their early forties about 1 in every 3 or 4.

As we have mentioned elsewhere, confirmed bachelors have a distinct tendency to turn more and more to prostitutes. Prostitutes are available on fairly short notice, there is no irritating uncertainty about whether or not they will agree to coitus, there is no time-consuming courtship, no emotional entanglement, the expense is no greater, and prostitutes usually compare favorably with nonprostitutes in physical beauty and bodily activity. The absence of affectional ties is no serious argument against coitus with prostitutes in the minds of many males, particularly males from the lower socioeconomic level who view sexual activity and love as two quite separate phenomena which are not necessarily related. In fact, some men of the double-standard school feel that sex and love are mutually exclusive-one loves and respects one’s wife or fiancee and, hence, spares her as much as possible the degradation of sexual activity. This attitude is now less common in the United States, but lingering traces of it still bolster the incidence and frequency of prostitution. Note that the three incest groups rank first, second, and third in the proportion of total outlet derived from prostitution between twenty-one and twenty-five, the same age-period in which most of them were marrying.

*298\161\2*

PREPUBESCENT SEX LIFE: PREPUBERTAL HEALTH

Monday, March 30th, 2009

In the process of learning to socialize with others, which plays an important role in subsequent sexual fife, physical health can be of great importance. Questioning each man in our sample, seeking to discover if frequent or protracted illness had interfered with his early life, we found that in general from 70 to 80 per cent reported good childhood health, 10 to 15 per cent fair health, and only 5 to 10 per cent poor health. The healthiest were those in the sex-offender groups who had been involved with females aged twelve and older. The control and prison groups are similar to most sex-offender groups, while the homosexual offenders report the poorest health, particularly the homosexual offenders vs. adults (the most homosexually oriented of all homosexual groups). They had the fewest, 55 per cent, who reported good health, and the most, 16 per cent, who reported poor health. In contrast, the heterosexual offenders vs. adults reported 84 per cent with good health and 5 per cent with poor health.

All this would lead one to envision a picture wherein the heterosexual offenders were outdoors with rosy cheeks happily playing with many other children while the homosexual offenders remained indoors alone with their medicine. This, as we shall see, is a false picture. Insofar as we may generalize from our data, only in extreme cases does poor health seriously interfere with socialization with other children. A sickly child may refrain from violent sports, but this does not preclude his having many companions of both sexes. However, ill health may prevent a boy from becoming a part of, and identifying with, what one may call “boy culture” with its early elements of roughness, courage, and other traditional masculine attributes of our culture.

*260\161\2*

PEEPERS: HETEROSEXUAL PETTING

Monday, March 30th, 2009

Of all the groups, the peepers included the fewest members who had petted (91 per cent). Those with petting experience tended to begin at a relatively late date, the median peeper having his first postpubertal experience at sixteen years of age—the third oldest median age. This late start accounts for the small number who petted before they were sixteen, but within the following age-period 16—20 some 90 per cent (a figure neither high nor low in comparison to other groups) engaged in heterosexual petting.

The accumulative incidence, the percentage with petting experience by a given age, gives a somewhat different picture. By age twelve one third, a moderate figure, had petted; by age fourteen the peepers are in the lower part of the rank-order with 41 per cent; and by age sixteen they are still in the lower third of the rank-order with 65 per cent. However, by age eighteen they have risen to a middle position with 88 per cent. This is what we saw in the age-specific incidence figures which showed little activity between puberty and age fifteen and a moderate amount between ages sixteen to twenty.

Relatively few of the peepers achieved orgasm from petting during any five-year age-period up to age twenty-five; thereafter the incidences are moderate. The accumulative incidence of petting to orgasm reached a maximum of 25 per cent by age twenty-three, also a moderate figure. Because our sample of peepers is not large and since few of them reached orgasm through petting in any age-period, we have not calculated their frequencies.

Since the peepers did not get along well with girls in their preadolescent years, one is prepared for the fact that at ages sixteen to seventeen they had the fewest female companions and friends. No less than one quarter reported none at all. The control group, which can scarcely be considered as consisting of Don Juans, had only 15 per cent of its members in this unfortunate situation. Conversely, the peepers had the fewest members (29 per cent) who reported having had numerous female companions.

With this in mind, one would expect to find that they had had the fewest petting partners. However, our sample of peepers seems to consist of two disparate subgroups, one being the inhibited deprived group, as anticipated, but the other being a sexually more successful and rather promiscuous group. At any rate, the peepers have a curious bimodal distribution in numbers of petting partners: they rank second (9 per cent) among those with no partners, high among those with one partner (9 per cent), and in the successive categories of larger numbers of partners their positions in the rank-orders are middle to low. In the ultimate category of over 100 partners only one peeper (2 per cent—the second lowest percentage recorded) is represented, whereas the control group has 15 per cent. The average (median) peeper had petted with 14 females, the fourth smallest number reported. Yet amazingly enough in the category of 51 to 100 partners the peepers rank first with 22 per cent, a proportion considerably in excess of any other group and one that can scarcely be explained away as a vagary of small sample size.

The more sexually restrained subgroup of peepers reduced the percentage of peepers who had engaged in premarital genital manipulation with females: 82 per cent had this experience, a rather small proportion. On the other hand, the sexually active subgroup seems to have raised the percentages of peepers involved in cunnilingus and heterosexual fellation to middle positions in the various rank-orders. In any case, the peepers are not distinctive for mouth-genital contact with females except with regard to extramarital and postmarital partners.

With these females some 28 per cent of the ever-married peepers had cunnilingus, a percentage earning them first place in this particular rank-order.

*221\161\2*