Archive for May, 2011

ADULT SEXUALITY: EARLY ADULTHOOD

Friday, May 27th, 2011
The phase of early adulthood, from approximately ages twenty to forty, is a time when people make important life choices (marriage, occupation, life-style) and move from the relatively untested ambitions of adolescence to a personal maturity shaped by the realities of the world in which they live. For most people, it is a time of increasing responsibility in terms of interpersonal relations and family life.
In recent years, both in the United States and abroad, there has been a definite trend toward marriage at a later age than in past decades. As a result, many young men and women face an extended period of being single after adolescence that unquestionably changes patterns of sexual behavior from Kinsey’s day. Today, most people in their twenties believe that becoming sexually experienced rather than preserving virginity is an important prelude for selecting a mate. Erikson remarked in 1968 that developing the capacity for intimacy is a central task for the young adult.
Young adults are generally less subject to “sexual peer pressure” than adolescents but more driven by an internal need to become sexually knowledgeable. Freedom from parental limits is accompanied by easier access to private surroundings (an apartment, a motel room, a vacation spot), which also creates more sexual opportunity. In this state of singlehood, several common patterns of sexual behavior can be seen. The experimenter seems to judge sexual experiences in terms of frequency, variety, and performance proficiency. She or he seems to view the world as a sexual smorgasbord and generally has the attitude that “now’s the time to play, because later I’ll settle down.” The seeker strives to find the ideal relationship (and perfect marriage partner) by developing sexual relationships and hoping for the best. Living together can be a proving ground for a relationship begun on this basis. The traditionalist participates willingly and joyously in sex, but reserves intercourse for “serious relationships.” The traditionalist may have several sexual partners before ultimately marrying, but does so one at a time. There are undoubtedly other patterns that can be identified, but these three seem to be most common.
The early years of adulthood are a time of sexual uncertainty for some and sexual satisfaction for others. Conflict can arise because of attitudes of sexual guilt or immorality carried over from earlier ages. The adolescent’s concern with sexual normality has not fully disappeared, and the young adult continues to worry about his or her physique, sexual endowment, and personal skill in making love. Sexual identity conflicts may not yet have been resolved, and even for those who have, come to accept themselves as homosexual or bisexual, social pressures and prejudice? may cause some difficulty.
Despite the existence of such problems, young adults are more sexually active today than in the past. A major factor contributing to this change has been the relative disappearance of the old double standard that regarded premarital sexual experience as permissible for men but not for women. Thus, it is not surprising to see that the gender gap in premarital sexual experience has narrowed considerably from what it used to be.
Today’s young adults are faced with some additional sexual conflicts that may represent a sort of backlash against the “anything goes” banner of the sexual revolution of the 1960s and 1970s. For example, while attitudes toward premarital sex have changed dramatically in the last three decades, having sex with a large number of partners is still somewhat frowned on. Furthermore, although most singles don’t believe that love is necessary for good sex, there seems to be increasing disillusionment with casual sex or one-night stands.
This trend seems to be at least partly the result of increased awareness of the possibility of exposure to a sexually transmitted disease, such as the much-publicized genital herpes. Among young adult homosexual men, who have — as a group — typically participated in casual sex much more than their heterosexual age-mates, fear of contracting AIDS has also led recently to a reduction in the number of sexual partners and more interest in establishing “monogamous” relationships. Fear is not, however, the only element operating here. Many of the young adults we have interviewed are concerned with another aspect of casual sex: its relatively impersonal nature. The following remarks are typical of what we have been told:
A twenty-six-year-old man: Having one-night stands was fun at first because there were no demands attached, no one’s expectations to fulfill. But after a year or so I began to realize that something was missing from these encounters — a sense of caring about the person I was making it with, or a feeling that she cared about me.
A thirty-year-old woman: You just can’t compare the quality of sex with someone you hardly know and feel nothing for with the quality of sex in a caring relationship. Casual sex is just mechanical, one-dimensional release. Sex with someone I care about is warmer and psychologically far more satisfying.
Why are a number of young adults becoming disillusioned with having only casual sexual encounters? Peter Marin, in an article titled “A Revolution’s Broken Promises,” offers one interesting analysis of what may be occurring: he suggests that while loosening restraints on sexual behavior creates a climate of sexual freedom and choice, this freedom is not unequivocably positive. Sexual freedom can lead to disappointment, pressure, and conflict as well as satisfaction, so that “To the extent that it diversifies and expands experience, it also diversifies and multiplies the pain that accompanies experience, the kinds of errors that we can make, the kinds of harm we can do to one another.”
Similarly, Susan Washburn claims that the commercialization of sex in our society leads to completely unrealistic expectations of what sex should be:
When sex is treated as a commodity, the consumerist credo, “more is better” is extended to sexual interactions. If one partner is good, two are better, and an orgy the ultimate sexual experience; if one orgasm is good, a Chinese firecracker string of multiple orgasms is better. . . . We collect sexual experiences with the same compulsiveness that marks our accumulation of material goods. We’re afraid that we won’t get ours before the supply runs out.
To be sure, sexual experiences in early adulthood are often warm, exciting, gratifying, and untroubled. Even casual sex can serve a number of useful purposes, psychologically as well as physically, and there is certainly no reason why having fun is to be frowned on. But the prevailing trend is clearly toward sex in the context of caring relationships, and one place this is particularly evident is in the relatively recent growth of cohabitation — unmarried heterosexual couples living together.
Pregnancy may influence a couple’s sexual activity, although it has no uniform effect on sexual feelings or function. For some women, pregnancy is a time of heightened sexual awareness and sensual pleasure, while for others no changes are noticed or sexual feelings decline. Some couples find that late in pregnancy the awkwardness of a bulging belly and concern about the baby lead to voluntary abstention from sex. For others, adjustments in sexual positions or the use of non-coital sex play solves these problems fairly easily.
There is marked variation in patterns of sexual behavior in the first trimester of pregnancy. Not surprisingly, women with morning sickness and high levels of fatigue report losing interest in sex and a lower frequency of sexual activity, but other women experience just the opposite effects. In the second trimester, however, 80 percent of pregnant women note heightened sexuality both in terms of desire and physical response. In the last trimester, there is typically a pronounced drop in the frequency of intercourse. While many women think this happens because they are less physically attractive, husbands generally deny this explanation and instead voice concern about injuring the fetus or their wife.
A few practical guidelines about sex during pregnancy are in order. Women who have a history of previous miscarriages or whose pregnancy is in danger of miscarriage should abstain from any type of sexual activity that might result in their having orgasms, since contractions of the, uterus during orgasm could be risky. If vaginal or uterine bleeding occurs during pregnancy, it is also wise to avoid all forms of sexual activity until receiving a medical okay. Air blown forcefully into the vagina during oral-genital contact can be dangerous for the pregnant woman, if it causes air embolism (air bubbles in the bloodstream). Cunnilingus without air blown into the vagina is not risky. If the membranes have ruptured, intercourse or cunnilingus should be prohibited because of the danger of fetal infection. Aside from these few cautionary notes, sex during pregnancy is quite safe for the fetus and the mother.
Despite the fact that divorce doesn’t always provide as neat a solution to problems as many people think it will, there are certainly many instances in which divorce is the soundest option available. Knowing when to put an end to an unpleasant or painful relationship is often a key step toward creating the chance for a new start.
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CANCER TREATMENTS: RADIOTHERAPY

Friday, May 13th, 2011
Treatment with radiation has been used in gynecological cancers for more than 100 years. Radiation works by destroying the chromosomes inside cells thereby preventing the cell from dividing and growing. Unfortunately, the radiation beam often passes through normal tissue so that side effects can occur. However the side effects depend on what other organs are in the immediate area being radiated. Side-effects can include cystitis when the bladder is affected resulting in burning when passing water and often having to urinate frequently. Likewise, the rectum can become inflamed, diarrhea can occur and occasionally bleeding from the back passage.
If the woman is pre-menopausal then the ovaries may be in the way of the radiation beam and will stop producing hormones. The radiation specialist will discuss possible side effects with each patient and ways that they can be reduced. It should be noted that many of these side-effects can be long lasting and may require counseling to help you to adjust to your sense of loss and the changes in your lifestyle. It also requires sensitive support and understanding by your carer or partner, especially if you are a young woman yet to form a permanent partnership and family. Radiation to the vulva will cause skin changes, but it is rare for other sites to change.
It is important to ask how long the side effects usually last so that at least when you are at the mid-point of treatment you have a sense of when it will finish.
I did go into instant menopause after radiotherapy, but as I had no intention of having a child I was not concerned about the loss of fertility. I was really relieved never to have a period again. I haven’t had any mood swings-just the hot flushes. I’m on HRT because of osteoporosis later. It keeps me sexually active. The six and a half weeks of radiotherapy left surface burns and scars almost like bicycle shorts, just waist down to my thighs. It’s all healed up now. It started off like sunburn, which got worse and worse.
When I was given that six weeks time span I thought ‘Oh good, then there’s a light at the end of this tunnel.’ So I didn’t feel that bad if they would have said it would be three months before they heal. I might have been depressed.
So it was important knowing that each thing was a finite span.
Lillian
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NATURAL HISTORY OF TYPE 1 DIABETES: EFFECT OF INTENSIVE MANAGEMENT – HYPOGLYCEMIA

Sunday, May 8th, 2011
The major adverse event in the DCCT was a threefold increase in the incidence of severe hypoglycemia in the intensively treated group. Severe hypoglycemia was defined as an episode with symptoms consistent with hypoglycemia, in which the patient required the assistance of another person and which was associated with a blood glucose level <50 mg/dl or prompt recovery after oral carbohydrate, glucagon, or IV glucose. A total of 65% of patients in the intensive group had at least one episode of severe hypoglycemia vs. 35% of patients in the conventional therapy group. Overall rates were 61.2 per 100 years in the intensive group and 18.7 per 100 years in the conventional group. A history of severe hypoglycemia in the past was the best predictor.
Subgroup analyses showed that males, adolescents, and patients with no residual c-peptide secretion had a particularly high rate of severe hypoglycemia in both treatment groups. Intensive treatment was also associated with an increased risk of multiple episodes of severe hypoglycemia within the same patient. Approximately 25-30% of intensively treated patients vs. 5-11 % of the conventional group had severe hypoglycemia year, and about 10-12% vs. 3-5% resulted in a coma or seizure respectively in the two treatment groups. No changes in neuropsychological function were noted.
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