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Limitation In behavioral impotence is a horrifying thing discount 100/60mg viagra with dapoxetine free shipping, clinical or social research erectile dysfunction 40s order viagra with dapoxetine on line, experimental and developing procedures may be employed when the risk/beneit ratio has been carefully assessed and there is full disclosure to erectile dysfunction free samples cheap viagra with dapoxetine online visa the re-- search participant erectile dysfunction drugs in australia discount viagra with dapoxetine on line. In education and health promotion innovative techniques may be used giving due regard to the social and cultural context and participants are appropriately informed. Principle 6: Sexologists have a responsibility to maintain and enhance the knowledge, health and welfare of their communities Application: Actions taken on behalf of a client, patient or community may have an undesired affect on others, including groups within a society or the society itself. Sexologists should have regard for the impact of their proposed actions and make a decision based on the greater good. Application: Sexologists should act in a manner that does not bring disrepute upon their colleagues or their profession. They should act on prin-- ciples of fairness at all times and not take actions that undermine individual colleagues. Limitation: Where a Sexologist has evidence that a colleague has acted unprofessionally is incompetent or otherwise acting inappropriately, the matter should be irst discussed with that colleague and, if necessary, brought to the at-- tention of relevant authorities. Application: Within the con-- text of the professional relationship the Sexologist must act with integrity at all times. A Sexologist must not engage in intimate relations with a client, research participant, student or patient, or otherwise place them in a position where the professional relationship is compromised. When the service is of a psychotherapeutic nature a Sexologist should not provide services to a close family member. Principle 9 The sexologist shall respect and uphold the autonomy and dignity of those receiving their professional services. Application: This principle applies irrespective of age, gender, race, ethnicity, educational level, sexual orientation, social circumstances, or political afiliation. It obliges the Sexologist to facilitate the exercise of autonomy through providing necessary and suficient information to enable rational decision-making. Limitation: Individual autonomy is limited by the recognition of the rights of others and the avoidance of harm. It is also limited through the capacity of an individual to make rational decisions on their own behalf. Informed consent must be irst obtained prior to disclosing information to third parties. Limitation: Under certain jurisdictions there is a legal obligation to report particular activities to certain authorities. Such decisions should be based on the legal and political circumstances and on what is deemed to be the greater good. Application: Prior to implementing any action the Sexologist should provide suficient and necessary information on the rec-- ommended activities and alternatives. The Sexologist may disclose which option is, in their professional opinion, the optimum action within a particular context. Limitation: Where the person is not in a position to provide informed consent, an advocate may act on their behalf. Application: Sexologists will maintain re-- cords on clients, client groups, patients or research participants. Such records may be used for research purposes when prior, written consent has been obtained. Principle 13: Sexologists will provide information on their fee schedule to potential clients Applica-- tion: Prior to the provision of services, information on fee schedules, insurance rebates and tax provisions, where relevant. Principles for the conduct of ethical research Principle 14: Sexologists shall employ recognized research protocols Application: All research ac-- tivities should follow an acknowledged research protocol that is deemed by peers to be appropriate to the nature of the study. Principle 15: Sexologists shall employ recognized protocols in the use of human research subjects Application: The use of human subjects requires adherence to the Helsinki Declaration, which includes the following: informed consent, potential beneit(s) must outweigh potential risk(s), freedom to withdraw without 200 comitte 4. Application: The use of animal subjects requires adherence to the protocol set down for the humane treat-- ment of experimental animals, which includes the following: appropriate housing of the animal subject mini-- mization of pain and discomfort and appropriate disposal at the conclusion of the study Principle 17: Sexologists shall utilize peer review to evaluate their work. Application: Research pro-- posals and research reports should be made available for expert and peer review. Principle 18: Sexologists have an obligation to provide support for, or to conduct research and to disseminate indings Application: Sexologists should contribute to the development of the body of knowl-- edge through the conduct of appropriate research and through dissemination of indings. This The inluence of culture on sexual behavior has sample has been utilized by many researchers to been extensively studied and documented. In a make sense of the variability observed amongst classic book reporting the differences on a variety cultures. Sociology has studied culture in several ways but Murdok and White and performed several statistical one of the clearest concepts proposed to study the analyses to attempt to identify culturally variable relationship of culture with human sexual behavior is sexual scripts, and culturally invariable sexual the concept of “sexual script” that basically proposes scripts [10]. Reiss conclusion after this analysis that members of a group are prescribed how to was that the following propositions could be held behave in terms of what to do, with whom to do it, after the analysis: 1. Societies judge stable social when and how to do it and with a rationale to do it to relationships as of great importance. Thus, culture acts through sexual physical pleasure and self disclosure as the building scripts at an individual level. Physical pleasures and self-disclosure are the common outcomes of A large number of anthropological and sociological sexual behavior. Therefore, sexual behavior will studies have documented the variability of sexual be seen as important due to its ability to promote behavior that can be attributable to culture [7]. Such stable bonding between the objective of this review is not to present a full genetic males and females produces a context for account of the cultural variability of human sexual the nurturance of offspring- 6. Stable heterosexual behavior, there is a need for the clinician working in relationships are the rudimentary bases for sexual medicine to be aware of the fact that culture husband-wife and parent-child roles; and thus in this has a very signiicant impact on how sexuality is sense, kinship an gender roles are derivative from understood and experienced in people?s lives. This need is particularly important for practitioners Important social relationships are culturally deined of sexual medicine who serve culturally diverse in ways that are intended to institutionalize protective populations. Therefore, marital sexuality I would be out of the scope of this chapter to cover the will involve jealousy norms concerning the ways, if amount of information which is published that refers any, to negotiate extramarital sexual access without to the speciic differences among cultural groups. A clinician, who inds and ways of practice, remains a classic example himself or herself in a situation where he or she is where cultural values collide with the minimum serving a patient from a culture not familiar to him, requirements to attain sexual health. Vaginal dryness is promoted by were originally isolated in a single cultural milieu) certain cultures as means of increasing male sexual have encountered a process of acculturation that pleasure but the health consequences on the female has made that the westernized cultural view of have been documented as deleterious [12]. Achieve recognition of sexual pleasure as a component of holistic health and well-being 1. The right to sexual pleasure should be universally Sexual rights are an integral component of basic recognized and promoted. Advance toward gender equality and equity of Interest in Medical Research, Education, and Practice; Institute of Medicine Sexual health requires gender equality, equity and 2. Gender-related inequities and imbalances scribing Among Ofice-Based Physicians Arch Intern Med. New york: Continuum International Publishing education and sexual health information and services throughout the life cycle. Dry sex in Zimbabwe and implica-- programs must be broadened to address the various tions for condom use. In addition, the Committee is charged to produce observations, conclusions and recom-- mendations regarding the economic aspects. Research should ket or consumer behavior and the identiication of also explore cultural and ethnic determinants in the inluencing factors economics of these conditions and societal impact of their treatment. Cost-effectiveness analyses can be investigation of a consumer or market response. Fe-- 2005-2006 comprised of 1455 men 57-85 years male sexual dysfunction involves disorders of sexual of age surveyed adults about sexual function and desire, arousal, orgasm and dyspareunia, which lead behavior via in-home interviews [7]. Approximately 9 to 25% of younger than 59 years to 61% in those older than sildenail responders discontinued successful 70 years old. In order to obtain accurate data of keep an erection adequate for sexual intercourse. In all regions, distress, bother, frustration and/or the avoidance of except Central/South America and Southeast Asia, sexual intimacy. The most international survey of 13,882 women 40-80 years remarkable increase is expected to occur in Japan, of age found that 39% of women reported a problem where in 2050; more than 1 in every 3 persons aged with sexual activity. It is disorders of sexual desire, world (Fig 1) projecting substantial increase in old arousal, orgasm and pain that lead to personal men and women with sexual dysfunctions. Sexual desire disorder include low desire, with a prevalence of 43% of women between 57- 85 years of age.
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This corresponds with the observed variations in health within women in Europe (Thummler et al erectile dysfunction medication for high blood pressure purchase viagra with dapoxetine 100/60 mg with visa. This recognition that such broad differences in health for men statistics for erectile dysfunction discount viagra with dapoxetine 100/60 mg mastercard, both across states and within states erectile dysfunction cancer buy viagra with dapoxetine 100/60mg otc, cannot lead to impotence over 60 viagra with dapoxetine 100/60 mg otc a conclusion that it is some form of biological inevitability that men will die prematurely (Walberg et al. Differences in how men and women live their lives and how they attend to health and illness are an important part of explanations for observed differences in men’s and women’s health. For example, men are less likely than women to seek help from professionals for a range of psychological, behavioural, and physical problems (Galdas et al. An important aspect of these more critical approaches to understanding men has been balancing the potential conflict between approaches which stress differences between men and women, and approaches which recognise the diversity of men’s and women’s experiences. Sometimes the male/female dichotomy highlights important differences between men and women, but it is also important not to think of men (or women) as one homogeneous group. Often these terms are used interchangeably, but they do have quite distinct meanings. Sex and sex differences are biologically-based, and refer to differences between male and female. Gender and gender differences are culturally-based, and refer to the active construction of masculinities and femininities; i. Masculinities and femininities are social constructions which may vary between cultures and across time. Gender and gender differences cannot simply be reduced to biological sex differences. Only approaches that separate social gender from biological sex can account for how and why some men are considered more or less masculine than others. It is now acknowledged that masculinity is not a single fixed entity: at any one time there may be a complex arrangement of patterns of masculine behaviour and discourses or definitions of masculinity (Connell, 1995). Contemporary theories of men and masculinities reject the notion that all men are characterised by a masculinity arising from innate, fixed, core characteristics. Of course there are some basic biological characteristics that all men possess and which distinguish all men from all women. However, there is also great diversity between men in terms of how they actively construct and shape their masculinity over time. There are also differences in the ways in which maleness and masculinity are linked to health and health-related behaviour. The influence of culture in shaping masculine identity begins early (Brody, 2000; Bronstein, 2006). For example, boys learn not to show physical or emotional vulnerability, and they are encouraged to strive for achievement and success (Moller-Leimkuhler, 2002). Indeed, some have argued that gender should not be thought of as a noun, but as a verb: masculinity is not something that men have, but something that they do (West & Zimmerman, 1987). Many health-related behaviours also have clear gender stereotypes, and may therefore be used to “do gender”. This idea is central to Courtenay’s theory of gender and health: 28 “health-related beliefs and behaviours, like other social practices that men and women engage in, are a means for demonstrating femininities and masculinities. The extent to which a man endorses and supports such traditional definitions of masculine and non-masculine behaviour will influence his patterns of health-related behaviour. Qualitative research has revealed that the extent to which men endorse “traditional” or “dominant” definitions or discourses of masculinity is related to unhealthy behaviours such as poor diet (Gough & Conner, 2006), excessive alcohol consumption (de Visser et al. Quantitative research shows that scores on measures of endorsement of traditional masculinity are related to different patterns of health-related behaviour (e. Beliefs about masculinity also influence men’s use of health services (Addis & Mahalik, 2003). For example, prospective longitudinal research reveals that after controlling for socio-demographic characteristics and health status, young men who had more traditional beliefs about masculinity were significantly less likely to use health services (Marcell et al. Research also indicates that greater endorsement of traditional beliefs about masculinity is related to more negative attitudes toward using counselling services (Robertson & Fitzgerald, 1992). However, more traditional men may be more likely to use counselling services if they are re-labelled “classes”, “workshops”, or “seminars”. In addition to considering how ideologies of masculinity may influence behaviour linked to disease onset, it is important to note the influence of male health professionals’ beliefs about masculinity. The influence of more traditional gender norms may lead to male health professionals ignoring or being unresponsive to male patients’ emotional distress (Moller-Leimkuhler, 2002). Within Europe there may be wide variation between countries in prevailing beliefs about masculinity and masculine behaviours. Such variation may reflect national-level factors such as national cultures, histories, and economies. It may also reflect regional or sub-cultural factors such as urban/rural residence. There was substantial variation in the extent to which men in these five European countries endorsed various components of masculinity. For example, whereas 44% of German men cited “being in control of your own life” as an important component of masculinity, only 17% of French men did so. As another example, 46% of Spanish men rated “being seen as a man of honour” as an important component of masculinity, but only 6% of German men did so. Given that masculinities are cultural and historical constructs, it is important to be aware that masculinities may vary as a function of cultural and historical differences. Masculinities may also vary within countries in relation to age, ethnicity, class, sexuality, and disability. Given the links between masculinities and health behaviour referred to earlier, we may therefore expect there to be variation across Europe in terms of how masculinity is related to health. How men perceive and actively define themselves as masculine impacts upon the value they place upon their health and how they manage their health within the healthcare system (Richardson, 2004). Indeed, it is against particular norms of masculine behaviour that men must constantly measure themselves – the dominant masculinity being the yardstick against which particular health practices are to be negotiated. It is crucially important however to consider and interpret gender and masculinities within the wider socio-cultural context of men’s lives and not in isolation from the social determinants of men’s health. As Ireland’s men’s health policy (Department of Health & Children, 2008, p14) highlights: 30 "It is imperative, however, that gendered health practices are not seen as inherent or intractable male characteristics, but rather, learned masculine behaviours that typically reflect wider cultural and institutional masculine ideologies such as those of schools or sporting organisations. The Commission on the Social Determinants of Health affirms that the conditions in which people grow, live, work have a powerful influence on health. It is important to acknowledge differences related to social class, ethnicity, sexual orientation etc, as well as similarities between men. How different men see themselves as being male is also crucial in acknowledging and respecting diversity within men. An appropriate men’s health policy has to face the multidimensional diversity within men and that there are many different ways to be a man. In the process of policy development men’s health should not be defined in a narrow biomedical framework, but should embrace a broader, social determinants view. In this respect, effective men’s health policy needs to draw on multiple strategies that target individual behaviors and that also focus on issues at the macro- economic, social, and environmental levels. In the case of socially excluded men health outcomes are very closely linked to education, employment, and housing. These factors are combined by issues such as social isolation and limited access to services for many deprived men. Permanent jobs are being replaced by short-term work contracts, rates of divorce are increasing, more children are born outside of marriage, and there is now a more level playing field in terms of equal opportunity in the workplace for men and women. There is much debate in Europe about men’s changing roles, the concept and different interpretations of the ‘new man’, and the degree to 31 which men are choosing to embrace or resist change and about their new vulnerability in health. Men’s health should be understood within a broad context, in the way that men actively construct their everyday life that impact on their health and in the framework of the culture in which men live and work. The positioning of men’s health within a mainstreamed equality/equity agenda may offer a more holistic approach than a focus on gender alone. In the Policy Brief of the European Observatory on Health Systems and Policies, Payne (2009, p iv) suggests that there are three basic approaches to address gender equality and gender equity: • Regulatory approaches at national level might address patient’s rights or create a duty for public sector organizations to address gender equality. Such a duty would require health ministries to consider the way in which health systems can reinforce inequality and to work towards the promotion of gender equality. For example, gender budgeting is an organizational approach that focuses on government expenditure and makes the gender impact of budgetary decisions explicit. For example, gender sensitive health indicators are intended to identify key differences between women and men in relation to health and in the social determinants of health, in order to support policy change. Gender mainstreaming represents a comprehensive strategy aimed at achieving greater gender equality.
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Thurstonb a University of Pittsburgh erectile dysfunction medication does not work buy viagra with dapoxetine 100/60 mg with visa, Department of Medicine, United States b University of Pittsburgh, Department of Psychiatry, United States a r t i c l e i n f o a b s t r a c t Article history: A satisfying sex life is an important component of overall well-being, but sexual dysfunction is common, Received 4 February 2016 especially in midlife women. The aim of this review is (a) to de?ne sexual function and dysfunction, (b) to Accepted 15 February 2016 present theoretical models of female sexual response, (c) to examine longitudinal studies of how sexual function changes during midlife, and (d) to review treatment options. Four types of female sexual dys- Keywords: function are currently recognized: Female Orgasmic Disorder, Female Sexual Interest/Arousal Disorder, Sexual function Genito-Pelvic Pain/Penetration Disorder, and Substance/Medication-Induced Sexual Dysfunction. How- Sexual dysfunction ever, optimal sexual function transcends the simple absence of dysfunction. A biopsychosocial approach Midlife Menopause that simultaneously considers physical, psychological, sociocultural, and interpersonal factors is neces- Aging sary to guide research and clinical care regarding women’s sexual function. Most longitudinal studies Women’s health reveal an association between advancing menopause status and worsening sexual function. Psychoso- cial variables, such as availability of a partner, relationship quality, and psychological functioning, also play an integral role. Future directions for research should include deepening our understanding of how sexual function changes with aging and developing safe and effective approaches to optimizing women’s sexual function with aging. Overall, holistic, biopsychosocial approaches to women’s sexual function are necessary to fully understand and treat this key component of midlife women’s well-being. Background A healthy and satisfying sex life is an important component of overall wellbeing for many midlife women. Thurston / Maturitas 87 (2016) 49–60 lence of sexual dysfunction peaks at midlife, with 14% of women aged 45–64 reporting at least one sexual problem associated with signi?cant distress [5], yet only 21% of women with persistent sex- ual problems discuss it with their healthcare provider [7]. The aim of this narrative review is to (a) review the de?nition of sexual dys- function, (b) understand the theoretical models of female sexual response, (c) examine the major longitudinal studies to understand how and why sexual function changes as women move through midlife, and (d) review the major treatment options for female sexual dysfunction. To diagnose any one of these disorders, the symptoms must be (a)presentatleast6months,(b)causeclinicallysigni?cantdistressin the individual [not solely in the individual’s sexual partner(s)], and (c) not be better explained by another issue, such as relationship distress or other stressors [8]. Incontrasttoasolefocusonsexualdysfunction,researchersand healthcare providers should consider overall sexual health to help women maintain a satisfying sex life. The World Health Organiza- tion de?nes overall sexual health as “a state of physical, emotional, mental and social well-being in relationship to sexuality; it is not merely the absence of disease, dysfunction or in?rmary. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and Fig. Measurement of sexual function Theoretical models of women’s sexual response can provide A number of instruments have been developed to measure a framework for understanding female sexual dysfunction. A Masters-Johnsonmodelwasoneofthe?rst,developedinthe1960s, more comprehensive review of available measures was published and applies to both men and women (Fig. Helen Singer Questions are graded on a Likert scale, and domains are weighted Kaplan, a psychologist and sex therapist, noted that many individ- and summed to give a total score ranging from 2 to 36, with a cutoff uals had problems with sexual desire, denoting the importance of of less than 26. Another commonly used instru- (or “sexual drive”) on the part of the woman is not always the start- ment in sexual function studies is the Female Sexual Distress Scale ingpointforsexualactivity. As discussed above, a diagnosis of sexual dysfunction seekoutsexualstimulationortobemorereceptivetosexualstimu- requires signi?cant sexually related distress in addition to a sex- lation initiated by her partner. Thurston / Maturitas 87 (2016) 49–60 51 Table 1 Measurement tools for female sexual function and dysfunction. This perspective lies in contrast the concepts of desire (the interest in or urge for sexual activity) to the Masters-Johnson-Kaplan model, in which desire always pre- and arousal (sexual excitement and pleasure) are dif?cult to dis- cedes arousal. Qualitative research suggests that for many women, tinguish; when asked to describe sexual desire, many women use 52 H. Thurston / Maturitas 87 (2016) 49–60 language that describes genital sexual arousal [19–21]. Finally, the Among the studies that used a multidimensional assessment of Bassonmodelacknowledgesthatbothphysicalaswellasemotional sexual function, there were differences regarding which aspects of satisfaction are important outcomes of engaging in sexual activ- sexual function were most affected by menopause. This physical and emotional satisfaction and can lead to higher wave of the Massachusetts Women’s Health Study, sexual desire, emotional intimacy, which in turn can lead to greater receptivity but not satisfaction, frequency, arousal, orgasm, or pain, were neg- and seeking out of sexual stimuli, hence the circular model. The Melbourne There has been debate regarding which model best re?ects Women’s Midlife Health project found that all domains of sexual the experiences of women. In a study of 133 women [22], most function, including responsivity, frequency, libido, and pain, wors- of whom were in their 40s and 50s, 30% endorsed the Masters- ened with advancing menopause status [27]. The Penn Ovarian Johnson model, 27% endorsed the Masters-Johnson-Kaplan model, Aging Study found the sharpest decline in the lubrication domain and 29% endorsed the Basson model. Notably, 3 out of 4 of these studies noted declines in sexual desire A subsequent study of 404 women with a mean age of 35 during the menopause transition. Many studies note a positive correlation between over- the Basson model to combine the responsive desire and sexual all physical health and sexual function [26,30,31,34]. Availability arousalphases,womenwithsexualdysfunctionweremorelikely to of a partner is also signi?cantly related to better sexual function endorse the Basson model than the Masters/Johnson/Kaplan model [26–28,30,31,34]. Finally, indicators of higher socioeconomic in the Masters-Johnson-Kaplan model [24]. One challenge is Johnson-Kaplan model is useful for conceptualizing the physical the measurement of sexual function. These studies used differ- aspects of female sexual function and dysfunction, whereas the ent instruments to assess female sexual function, and few used Basson model is useful for understanding the interplay between validated instruments. Another challenge is distinguishing sex- emotional, interpersonal, and physical aspects of sexual response. However, a diagnosis of sexual dysfunction requires aspects of sexual function, as an outcome measure. None of these lon- should include an evaluation of the psychosocial aspects of sexual gitudinal studies assessed sexually-related distress. Finally, female function re?ected in the Basson model, such as emotional intimacy, sexual function is a complex biopsychosocial phenomenon, and in studies of female sexual dysfunction, particularly since women a complete understanding of women’s sexual function requires with sexual dysfunction appear to be more likely to endorse this assessment of biologic, sociocultural, psychological, and interper- model. A multidimensional assessment of phys- In summary, most of the larger longitudinal studies using ical, interpersonal, and emotional aspects of sexual function will multidimensional assessments of sexual function do suggest that enhance the current state of the science on women’s sexual func- advancing menopause status has a negative effect on sexual tion. However, psychosocial variables also play an extremely important role in midlife women’s sexual function. Loss of a part- ner, changes in the quality of the relationship with one’s partner, and worsening mood symptoms are typically associated with 4. The biopsychoso- been, “How and why does sexual function change as women cialapproachrecognizesthatbiologic,psychological,interpersonal, progress through midlife and the menopause transition? Several and sociocultural factors can all affect female sexual function, and large longitudinal studies have attempted to answer this ques- these factors interact with each other in a dynamic system over tion (Table 2). Biologic factors may include hormonal changes that affect changes in sexual function and satisfaction over time than cross- libido or medical/anatomical problems that affect genital sex- sectional studies. Psychological factors includes mood symptoms, like women over time allow comparison of a woman’s sexual function depression or anxiety, or negative behaviors such as critical self- to herself, provide more effective control of between-subject con- monitoring during sexual activity. Some examples of interpersonal foundsandcohorteffects,andallowcharacterizationoftrajectories factors include general satisfaction in the woman’s relationship in sexual function over time. Vaginal some sociocultural factors to consider include the woman’s atti- dryness appears to play a key role in changing sexual function dur- tudes about menopause and aging, as well as religious, cultural, ing the menopause transition [29,30]. Researchers and health- longitudinal studies that only assessed sexual function using one care providers for women should consider all these factors when or two questions found that sexual activity and reports of desire addressing female sexual function. Thurston / Maturitas 87 (2016) 49–60 53 Table 2 Longitudinal studies of sexual function during midlife. Reference Study details Sexual function measure Key ?ndings George and Weiler [105] N=278 men and women Only used 2 questions to • Mean sexual activity remained relatively stable over the 6 years of Age 46–71 at baseline evaluate sexual function the study, especially among women 4 interviews 2 years apart Hallstrom et al. Thurston / Maturitas 87 (2016) 49–60 Table 2 (Continued) Reference Study details Sexual function measure Key ?ndings Woods et al. One outcome that may be more important to women than the while some aspects of physical sexual function may decline during physical aspects of sexual function is overall satisfaction with sex. This discrepancy Sexual satisfaction has been less well-studied than sexual func- betweenfunctionandsatisfactionmaybeexplainedbythefactthat tion. Treatments for female sexual dysfunction cial as opposed to physical; availability of a partner (especially a new partner), higher ratings of the importance of sex, fewer mood In order to help women maintain a satisfying sex life as they symptoms, and more positive attitudes about aging were asso- move through midlife and beyond, treatment of sexual dysfunction ciated with better emotional and physical sexual satisfaction. However, interpersonal, psychological, and psychosocialvariables,includingrelationshipsatisfaction,commu- sociocultural factors must be addressed as well.
Diseases
- Familial dysautonomia
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- Nonmedullary thyroid carcinoma, with cell oxyphilia
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- Gonadal dysgenesis, XY female type
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Do you know whether you have fast facts erectile dysfunction buy viagra with dapoxetine from india, or have had impotence lotion buy viagra with dapoxetine now, any diseases psychological erectile dysfunction young order viagra with dapoxetine uk, infections circumcision causes erectile dysfunction cheap viagra with dapoxetine 100/60 mg online, injuries, or prob- lems related to your: • Bladder? Yes ______ No ______ If so, identify the condition:______________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ • Bones or muscles? Yes ______ No ______ If so, identify the condition:______________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ • Ears, nose, or throat? Yes ______ No ______ If so, identify the condition:______________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ • Eyes? Yes ______ No ______ If so, identify the condition:______________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ • Immune system? Yes ______ No ______ If so, identify the condition:______________________________________________ ____________________________________________________________________ ____________________________________________________________________ EngenderHealth Men’s Reproductive Health Problems D. Yes ______ No ______ If so, identify the condition:______________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ • Prostate gland? Yes ______ No ______ If so, identify the condition:______________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ • Skin? Yes ______ No ______ If so, identify the condition:______________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ • Gallbladder, intestines (bowel), pancreas, rectum, spleen, or stomach? Yes ______ No ______ If so, identify the condition:______________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ • Thyroid, growth, or development? Yes ______ No ______ If so, identify the condition:______________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Reproductive and Contraceptive History 24. If you are having a sexual relationship with a woman, which contraceptive method(s) are you and your partner using to prevent pregnancy? Yes ______ No ______ If so, identify the concern(s): ______________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 29. Yes ______ No ______ If so, identify the concern(s) or question(s):___________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ EngenderHealth Men’s Reproductive Health Problems D. Become familiar with these questions so that you will be able to use them as needed. Note: Some of these questions assume that people have questions and concerns about sex, including disappointments related to sex and erection difficulties. The questions listed above are worded deliberately to let the client know that if he has such questions and concerns, he is not unique, and that it is acceptable to have such questions and concerns and to talk about them with a service provider. Follow-Up Questions Related to Sexual Satisfaction The following questions are appropriate to use with a client whom you think may have a problem with sexual satisfaction. They are intended to help you assess whether the client does, in fact, have a problem, the nature of the problem, and the primary causes of and contributing factors to the problem. Choose the questions in the list below that you need to ask in order to understand the client’s situation. You may want to schedule a separate visit to talk with the client about his sexual problem if there is not enough time when you first learn that he may have sexual concerns. General Sexual and Reproductive Health • During the past month, how often have you had sexual intercourse? Change in Sexual Frequency or Sexual Satisfaction • Have you had any change in how often you have sex or how interested you are in sex? Erectile Dysfunction • Are you able to achieve an erection each time you would like to have one? Some- times they get really worried about this problem, and it seems that the more they think E. Premature Ejaculation • Do you ever have an orgasm sooner than you or your partner would like? Follow-Up Questions Related to Contraception • How important is it to you and your partner to prevent pregnancy at this time? What effects from the medications have you noticed on your ability to function sexually? Is your sexual functioning getting better, getting worse, or staying about the same? Note: If a client has questions that you cannot answer or concerns that you are not prepared to address, be honest with him. Explain that you will try to find an answer or find another service provider who may be able to address his questions or concerns. A general health history should be obtained with a focus on the following areas: • Client’s age: Fertility declines in men who are over age 65. If his female partner is over age 35, the infertility evaluation should begin promptly due to her declining fertility, without waiting one year. Note: Sperm evaluation and the male reproductive examination should always precede the female infertility screening because a sperm assessment is simpler, less costly, less painful, and less invasive than the female infertility assessment. Precocious puberty may indicate adrenogenital syndrome, while delayed puberty may indicate Klinefelter’s syndrome or idiopathic hypogonadism. Chronic or repeated respi- ratory infections may be associated with one of several congenital abnormalities that lead to azoospermia or immotile sperm. Does it expose him to reproductive hazards such as lead, testicular toxins, or pesticides? Tuberculosis, malaria, filariasis, schistosomiasis, and Hansen’s disease may all cause infertility in some men. Many vaginal lubricants contain phenol, or are bactericidal, or may be sper- micidal, which can cause sperm immobility or death. Douching after penile-vaginal sex can wash out significant numbers of sperm and should be discouraged. Offer the client printed instructions for performing a genital self-examination to which he can refer as he begins to practice. Then, once you have taught him the technique for performing a genital self- examination, you can check to determine if he has been examining his genitals, verify his findings, and answer any questions he may have on subsequent visits to your facility. If you find out that the client has not been examining his genitals regularly or at all, you can encourage him to do so by explaining the following: “Do you examine your own geni- tals regularly? You can find testicular cancer—which is particu- larly common in young men—by self-exam, and also diseases that might be passed between you and your sex partner. You should get in the habit of checking your genitals routinely, about once a month. If any changes occur—and nondangerous changes, as well as serious ones can occur—you should call your health professional” (Swanson & Forrest, 1984). Performing a Genital Self-Examination Why You Should Perform a Genital Self-Examination • Genital self-examination helps detect testicular cancer in its early stages when it is highly curable, although in the very early stages there may not be any symptoms. Testicular cancer is one of the most common types of cancer in men who are between 20 and 35 years old. Men should start performing genital self-examinations as soon as possible around age 15 and continue on a regular basis until around age 40. When to Perform a Genital Self-Examination • Perform a genital self-examination once a month. How to Perform a Genital Self-Examination • Look at your scrotum, and check for swelling. The testicle feels like a large oval mass and is slightly rubbery, but not hard, with a smooth surface. Do not interpret this as an abnor- mality because, for example, you confuse it with a varicocele. With testicular cancer, the testicle feels very firm, nodular, or tender, and usually is not painful. Check for any lumps, blisters, sores, rashes, or changes in the color or texture of the penis and the scrotum. Remember to use condoms until you can be examined, so if you have an infection you will not spread it to someone else when you have sex. Write your observations and/or your suggestions for ways the participant can more effectively perform the task in the “Comments” box. Checklist for Performing a Genital Examination Very well Needs Task done improvement Comments 1. Perform a breast examination, and teach the client how to perform a breast self-examination. Inspect the scrotum, and teach the client how to perform a genital self- examination. 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