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When taken properly by your partner venogenic erectile dysfunction treatment generic extra super viagra 200mg on line, birth control pills are nearly 100 percent effective do herbal erectile dysfunction pills work cheap 200mg extra super viagra fast delivery. If a woman wants to treatment of erectile dysfunction in unani medicine purchase cheap extra super viagra on line avoid the inconvenience of taking pills every day erectile dysfunction youtube buy discount extra super viagra on line, she can have certain hormones implanted under her skin that are effective for as long as five years. Pregnancy-preventing hormones can also be injected, but they are effective for only three months at a time. Worn properly and used with a contraceptive foam or jelly, condoms can prevent pregnancy up to 99 percent of the time. This is a surgical procedure that involves disconnecting the tubes that carry sperm from the testicles to the penis. If you decide you want to have children later, it’s possible to reconnect the tubes, but there’s less than a 50-50 chance of success. R e m e m b e r, protecting yourself from unwanted pregnancy is as much your responsibility as it is your partner’s. So make sure you and your partner talk about birth control before you start getting undressed. You and your p a rtner may start focusing more on other intimate behaviors rather than just sex, but that may be an enjoyable thing for both of you! You probably w o n ’t respond to sexual stimulation as quickly as you did when you were younger. You may lose your erection after sex sooner and it may take longer for you to get another erection. But the two are connected in a kind of loop: the more attractive and desirable we feel, the better we’ll perform. At the same time, the better we perform sexually, the more attractive and desirable we feel. For this reason, it’s especially impor- tant to talk with your doctor about any sexual problems. If you don’t know what your prostate is or what it does, you’re certainly not alone. Over 30 million men suffer from prostate conditions that negatively affect their quality of life. And every year over 230,000 men will be diagnosed with prostate cancer and about 30,000 will die of it. But the others will develop one of three prostate diseases, or may have more than one. I t ’s the most common prostate problem for men under 50—so common that about half of adult men will be treated for it during their lifetime. There are three major types of prostatitis: • Bacterial prostatitis • Prostatodynia • Nonbacterial prostatitis Bacterial prostatitis. There are actually two types of bacterial prostatitis: acute (meaning it develops suddenly) and chronic (meaning it develops slowly over several years). Symptoms of acute bacterial prostatitis are often severe, and therefore are usually quickly diagnosed. A lthough the causes are unknown, the inflammation may be related to organisms other than bacteria, like a reaction to the urine or substances in the urine. For example, men with a history of allergies and asthma sometimes develop nonbac- terial prostatitis. Doctors know that nonbacterial prostatitis is not found in men with recurrent bladder infections. Symptoms include: • Occasional discomfort in the testicles, urethra, lower abdomen, and back. P r o s t a t o d y n i a (pain in the area of the prostate gland) occurs in about 3 out of 10 men with prostate irritation. Unfortunately, tests used to diagnose infection and other problems affecting the prostate gland are not useful in detecting the cause of this pain. In some instances, the pain may be caused by a muscle spasm (an involuntary sudden movement or contraction) in the bladder or the urethra. Symptoms include pain and discomfort in the prostate gland, testicles, penis, and urethra, and may include difficulty urinating. Some doctors use a symp- tom index questionnaire developed by the National Institutes of Health. Still, diagnosing prostatitis isn’t easy, so the most important diagnostic tool your doctor has is you and your detailed descriptions of your symptoms. Since the prostate gland continues to grow in most older men, their symp- toms may get worse with time. H o w e v e r, if left untreated, the condition can cause bladder infections and kidney stones, and in some cases, permanent bladder and/or kidney damage. To do that, your doc- tor may order tests to measure how quickly urine flows from the bladder, and he may do ultrasound or x-ray examinations of the bladder, kidneys, urethra and prostate. As part of watchful waiting, men continue to have annual examinations to determine whether their symptoms change over time. By relaxing the muscles around the prostate so that there is less pressure on the urethra, alpha-blockers usually work quickly to improve urinary flow. Common side effects can include stomach or intestinal problems, a stuffy nose, headache, dizziness, tiredness, a drop in blood pressure and ejaculatory prob- lems. Alpha-blockers include Cardura® ( d o x a- zosin mesylate), Flomax® (tamsulosin hydrochloride), Hytrin® ( t e r a z o s i n hydrochloride) and Uroxatral® (alfuzosin hydrochloride). Designed to shrink the prostate gland, it may take three to six months to effectively relieve symptoms. Side effects may include an inability to achieve an erection, decreased sexual desire and a reduced amount of semen. Examples of 5-alpha reductase inhibitors are Av o d a r t™ (dutasteride) and Proscar® (finasteride). There are several non-surgical approaches that use heat therapy to reduce the size of the prostate, thereby widening the urethra through which urine flows. These heat treatments include microwave therapy, radiofrequency therapy, electrovaporization and laser therapy. Side effects of surgery may include urgency and frequency of urina- tion for some period after surgery, difficulty in achieving an erection, blood in your urine, inability to hold your urine (incontinence) or a narrowing of the urethra (scarring). Flomax is a re g i s t e red trademark of Astellas Pharm a Hytrin is a re g i s t e red trademark of Abbott Laboratories U roxatral is a re g i s t e red trademark of Sanofi Synthelabo, Inc. Prostate cancer generally grows slowly and most men die with prostate cancer rather than from it (meaning that they die of some other cause). The lack of early symptoms and the overlap of symptoms with non-cancerous conditions make prostate cancer difficult to diagnose. Prostate cancer is most often diagnosed in men over the age of 65, but it is becoming more com- mon in men between the ages of 55 and 65. Also, bone scanning can look for prostate cancer that might have spread to the skeletal s y s t e m. Side effects include urinary incontinence (bladder control problems) that can last for weeks, and erectile dysfunction. Side effects include reduced sexual function, urinary troubles, intestinal difficulty, loss of appetite and hair. Your doctor will use a special needle to implant 80 to 120 pellets the size of a grain of rice directly in to the prostate. There are fewer sexual side effects but more urinary ones, and there can be damage to the rectum and lower intestines. Because the male sex hormone, testosterone, stimulates cancer cells to grow, you can take drugs to block testosterone production. Hormone therapy is usually not a cure, it’s just a way of stopping the tumor from growing. Side effects include breast enlargement, reduced sex drive, weight gain and reduction in muscle mass. One side effect of hormone therapy may be a reduction in testosterone (hypogonadism) which may lead to osteoporosis, which reduces bone mass and may lead to increased risk of bone fractures.
Following 12 weeks of treatment erectile dysfunction doctors in baltimore best purchase for extra super viagra, the subscale score was significantly lower in the treatment arm erectile dysfunction from steroids order line extra super viagra. Significantly lower scores on the storage subscales were noted after 12 months of therapy erectile dysfunction doctors in atlanta cheap extra super viagra 200 mg amex. These trials demonstrate a fairly consistent evidentiary base for an effect of combination therapy with an alpha-blocker and an antimuscarinic agent erectile dysfunction just before penetration extra super viagra 200mg with mastercard. The magnitude of the improvement appears to be small, although statistically significant, in many of these trials, based on the primary endpoint. However, secondary endpoints in several of the trials do suggest a meaningful difference with combi- nation therapy. It is important to note that these trials often selected for men with a preponderance of urinary urgency and frequency symptoms, i. Safety profiles with regards to uroselectivity have recently been reviewed for men (168). Effects on symptoms typically occur within 2 weeks; side effects include dry mouth, dry eyes, and constipation. Male Lower Urinary Tract Symptoms: Medical Management and New Therapeutic Targets 431 8. However, there are uncontrolled observational studies that suggest a positive effect. The therapies (albeit not antimuscarinic agents) that affect the bladder detrusor muscle include Botox injections directly in to the detrusor and neuromodulation. In the brain, skeletal muscle, and seminiferous epithelium, testosterone directly stimulates andro- gen-dependent processes. Testosterone is space Adrenal androgens derived from testicular and adrenal precursors. Dihydrotestosterone is a more potent androgen than testosterone, because of its higher affin- ity for the androgen receptor. Conversely, androgen withdrawal from androgen-sensitive tissues results in a decrease in protein synthesis and tissue involution. The prostate, unlike other androgen-dependent organs, maintains its ability to respond to androgens throughout life. In fact, there is evidence to suggest that nuclear androgen receptor levels may actually be higher in hyperplastic tissue than in normal controls. There is little doubt that andro- gens have at least a permissive role in the development of the disease process. Morphological analysis of biopsy specimens showed regression of glandular epithelium. However, this form of treatment could be applicable only in carefully selected patients who are not surgical candidates, and it would have to be maintained indefinitely. Male Lower Urinary Tract Symptoms: Medical Management and New Therapeutic Targets 435 8. Studies in mice suggest that the type 1 enzyme is particularly important in the catabolism of androgens and other steroids, whereas the type 2 enzyme is important in androgen synthesis, although both isoenzymes participate in anabolic and catabolic processes. The genes that encode the isoenzymes are located on different chromosomes, but the homologous coding sequences reflect a common evolutionary precursor. Dihydrotestosterone and testosterone bind to the androgen receptor and activate the protein in the same manner, with similar association rates. These patients have non-palpable prostates as adults, despite otherwise normal virilization at puberty. The virilization at puberty was attributed to the sudden increase in testosterone production in the testes. The pharmaceutical industry became interested in the deficiency in the 1980s, and the idea emerged to mimic the deficiency syndrome, since affected individuals had no other signs of any illness. With both drugs, there is a noticeable initial increase in serum testosterone of about 10%–20% in several clinical studies (202,203). Table 24 summarize some of the most important differences between finasteride and dutasteride. In men treated with finasteride over 12 months, the prostate epithelium progres- sively contracts from baseline (tissue composition: 19. The percent epithelial contraction was similar in the peripheral and transitional zones (p= not signif- icant). Studies comparing fnasteride to other drugs or combinations, with fewer than 100 individuals in each treatment arm, or with a duration less than 1 year are not listed. Studies comparing fnasteride to other drugs or combinations, with fewer than 100 individuals in each treatment arm, or with a duration of less than 1 year are not listed. In addition, there have been open-label extension studies done in patients participating in the randomized, placebo-controlled phase 3 studies, as well as in other studies, providing additional longer-term efficacy and safety data up to 10 years (209,210,236,237). Symptom and fow rate improvements The available studies demonstrate that treatment with finasteride induces a significant decrease in symptom score compared to placebo after 1 year of treatment (–21% vs. The open-label extension studies with finasteride have demonstrated that this level of symptom improvement is maintained for as long as the patient takes the drug (236). Two randomized, placebo-controlled trials of 1 year’s duration were performed in which men received placebo vs. Finasteride was not found to be superior to placebo in either of these two trials, nor was the combination therapy found to be superior to the respective alpha-blocker treatment. A 5-year open extension of an initial double-blind period showed a mean Qmax improvement of approximately 13% in patients treated with finasteride 5 mg/day. In a 12-month placebo-controlled trial, finasteride caused a moderate but significant decrease (?8. Of the finasteride-treated cases, 75% were obstructed and 25% were equivocal at baseline, compared with 67% and 33%, respectively, at month 12. These results have been confirmed by others, who found that the percentage of patients obstructed by the Abrams-Griffiths classification decreased from 76. Placebo-controlled clinical trials have also shown that finasteride reduced the risk for surgery from 6. This benefit was maintained throughout the 6-year open-label extension study (232). Male Lower Urinary Tract Symptoms: Medical Management and New Therapeutic Targets 447 24 22. In addition, dutasteride has a serum half-life of 5 weeks, compared to the much shorter 6- to 8-hour half-life of finasteride. However, at 4 years, the improvements in the original placebo groups were smaller than those in the original dutasteride group (206). This is in contrast to the body of evidence for finasteride discussed previously, and may be partially responsible for the different clinical outcomes. Male Lower Urinary Tract Symptoms: Medical Management and New Therapeutic Targets 455 Urodynamic changes One small randomized, double-blind, placebo-controlled trial of 6 months’ duration directly assessed obstructive parameters derived from pressure-flow studies. Qmax) nor any of the secondary outcome parameters were statistically significant compared with placebo. Of the patients randomized, 1,454 completed the 12-month double-blind phase (719 dutas- teride; 735 finasteride). The patients were randomized in to two groups: one group received finasteride 5 mg plus alfuzosin 10 mg or tamsulosin 0. All patients received combina- tion therapy for 1 year, followed by 1 year of alpha-blocker monotherapy. A total of 464 patients (29%) experienced clinical progression, 297 (36%) of whom were receiving placebo, and 167 (21%) of whom were receiv- ing dutasteride (p<0. Both dutasteride and finasteride are known to increase serum testosterone by 10%–30% from base- line, with a greater increase in men with lower baseline levels (which could be a regression-to-the- mean phenomenon) (203,269–271). Finasteride and dutasteride are generally well tolerated, with the most prevalent adverse events being sexual function–related, such as impotence, decreased libido, and abnormal or decreased volume of ejaculation. However, these side effects are rare compared to those associated with traditional anti- androgen treatment, typically appearing in the first year of treatment in 5%–10% of patients. Adverse Event Time of Onset Adverse Event Dutasteride (n) Months 0–6 Months 7–12 Months 13–18 Months 19–24 Placebo (n) (n=2,167) (n=1,901) (n=1,725) (n=1,605) (n=2,158) (n=1,922) (n=1,714) (n=1,555) Impotence Dutasteride 4. In the untreated control group, hematuria recurred in 17 patients (63%) within a year, but in only 4 patients (14%) in the finasteride group, which was a statistically significant difference (p<0. Surgery was required for bleeding in 7 control patients (26%), while no patient on finasteride required surgery. Vascular endothelial growth factor expression was examined by immunohistochemistry.
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Yet, cancer treatment have damaged pelvic nerves and almost no empirical data are available about sexual vasculature or reduced hormone production, but the development in young survivors. Some will not even intensive conditioning to prepare for hematologic go through natural puberty without hormonal support transplantation, as well as the ongoing psychological [531], and a larger group bears visible signs of their stress exacerbate sexual problems. Unmet needs were Local estrogen therapy is recommended for women particularly acute in the group aged 18 to 29, whose with premature ovarian failure and dyspaereunia. Systemic estrogen may be appropriate in some age at diagnosis put them in the Adolescent and cases: Grade C. We recommend giving information to men and women about sexual problems and rehabilitation Even once these young people reach adulthood, before starting cancer treatment, with further research on sexual function seems to be off limits. Seventy percent of the 66 eugonadal who survive these malignancies remain vulnerable to men met criteria for being sexually functional, but increased mortality from cancer recurrence, second this still suggests a higher rate of problems than malignancies, and late health effects of their cancer expected among young men. Research on the quality of life of study of childhood cancer survivors [536] included 31 survivors of cancer in childhood and adolescence young men and 29 young women with a mean age has rarely investigated sexual function, however. Although both genders were included, rates Rates of marriage have been compared with of problems were mainly cited for the group as a those of siblings or healthy peers in large cohorts whole. In those over age 25, experience with sexual followed longitudinally in the United States [526,527] intercourse was signiicantly lower than age norms and Britain [528]. Being diagnosed during several sizable, but smaller surveys [525] agree that both men and women have lower rates of marriage adolescence led to delays in sexual development in than healthy peers or sibling controls. The impact terms of dating, experimenting with intimate touch, is mild, however, except in men exposed to cranial intercourse, and for women, with masturbation. The past ten years have brought a veritable of note, these two surveys were conducted in 461 comitte 9. In more detailed research is needed to enable clinicians ofice endometrial biopsy or operative curettage for to understand risk factors for sexual dysfunction postmenopausal bleeding has lead to early diagnosis after cancer in childhood and adolescence so that coupled with a favorable prognosis and a survival services can be directed to the subgroups most in of 85-90% at ive years. A written workbook, using clip at high risk for developing vaginal agglutination and art and text layouts designed to appeal to teenagers stenosis within the irst 3 months after radiotherapy and young adults included the following topics: [540]. Recent studies demonstrate that between male and female sexual anatomy and response, 30-63% of women who undergo treatment for the impact of cancer treatments on sexual function cervical cancer experience some sexual complaint and fertility, ways to develop a positive body [541]. The sudden loss of ovarian hormones from image, making good decisions about whether or surgery or chemotherapy also contributes to sexual not to be sexually active, using contraception for dysfunction. Half of with these diagnoses consider their sexual health participants were randomized to a 3-month waiting to be one of the three most important aspects of list condition and half to two 90-minute sessions quality health care [542] and while 74% in one study of counseling from an expert psychologist, along believed their physicians should discuss sex [543] with receiving the workbook. The and optimal treatment are scant especially for only change during the waiting list period was an endometrial and fallopian tube cancers. Despite having the AyA programs of two large stages and follow up times are variable. Most pediatric oncology centers participating, recruitment studies are retrospective and do not have baseline for this trial was very slow and dificult, limiting its sexual functioning. In the future, it might be Institute, research shows that approximately one- more acceptable to teens to use an internet-based half of women who have been treated for breast or peer counseling model along with the material in and gynecologic cancers experience long-term the workbook. Sexual outcome and the advent of menopause (see table for effects) must be followed as therapeutic interventions [565] Bowel resections and anterior/posterior become less aggressive and laparoscopic robotic exenerations for advanced gynecologic malignancy surgical dissection becomes more prevalent can result in stomas, colostomies, and ileoconduits and minimally invasive treatment becomes more impacting on self image. Same sex couples as well as minority are becoming less aggressive without impact on women need to be included. There are on going studies of radical tracelectomy the highly prevalent but commonly ignored sexual (which preserves fertility) for early cervical disease sequelae of gynecological cancer should be and subsequent sexual function. Sexual self schema may account for variance in predicting current sexual behavior Minimally absorbed local vaginal estrogen is in cancer survivors; those with positive self sexual recommended for most gynecological cancer concept may adapt more positively [546]. Recently survivors for dyspareunia from estrogen deiciency: studies have noted the success of brief psychosexual the clinical implication of the minimal absorption interventions and of addressing the informational remains to be further elucidated: Grade C. The focus is on both the psychosexual Breast cancer is the most common malignancy in and physical aspects of sexuality. Twenty-ive Palliative care providers can also be involved as they percent of new cases present before menopause reassure patients and their partners that even at the and 15% present before the age of 45 [577, 578, end of life, when intercourse may not be feasible, 579]. Sexual concerns are distressing complications physical sexual intimacy and emotional closeness for women during their diagnostic, treatment, and can be encouraged. In addition many women choose to undergo Women of Asian [583] or African American [584] prophylactic mastectomy of the breast unaffected [585] descent may be less communicative about by cancer fearing bilateral involvement or another sexual health concerns and possibly more prone primary breast cancer. Study of subsequent sexual to sexual dysfunction after breast cancer, but this function is scant but cosmetic results are not always has yet to be determined. There is limited study on favorable and may negatively impact sexual self breast cancer survivors who are lesbian, bisexual or esteem. Skin damage, fatigue, alopecia, diarrhea, nausea, There may be fear of recurrence, hesitancy to start vomiting and radiation-induced symptoms contribute a new relationship with need to disclose medical to general malaise and negatively impact sexual details, fear of rejection by a partner, coupled with desire and response. Studies are lacking with the stress and sadness of possible changed fertility, respect to Mammocyte ®, a novel minimally invasive life plans and inances. However, studies conclude intramammary placement of radiation at the time of that major factors negatively inluencing sexual are surgical intervention and its implications on female also treatment related, see table 49. Sexual problems the probability that a woman will enter menopause may be more signiicant immediately after surgery as a result of chemotherapy increases dramatically and some gradually decrease with time, but there is at the age of 35. More than 40% of women receiving still a need to address sexual problems related to the chemotherapy at the age of 40 become amenorrheic breast surgery and possible iatrogenic menopause, [592]. Weight gain with chemotherapy and hormonal especially in younger breast cancer survivors [587]. Goodwin et al [594] noted a a genetic predisposition for the development of mean overall weight gain of 1. Table 48: Prevalence of Sexual Complaints after Breast Cancer [546, 569, 583, 586, 587, 597] Estimated Prevalence Sexual Complaint Research Study 50% All complaints Ganz et al (1998)[597] Robinson et al (1998)[569] 30-100% All Complaints Robinson et al (1998) [569] Anderson et al (1997)[546] 23. Careful attention should be addressed weak estrogen agonist on the uterine lining requiring to her relationship and social support network as monitoring for adverse endometrial effects. Aromatase inhibitors (Anastrozole, Letrozole, and It is imperative to counsel patients concerning Exemestane) are rapidly becoming the mainstay of possible sexual remedies including treatments treatment for various stages of breast cancer. Since breast cancer is drugs prevent the production of any estrogen and often hormonally sensitive and tumor cells possess many women complain of vaginal dryness, moderate estrogen and progesterone receptors, treatment of and severe dypareunia, exacerbated menopausal menopausal sequelae with systemic replacement symptoms, and loss of sexual desire [596]. Management may include encour-- use of alternative medications, including serotonin agement of non penetrative sex if non estrogen vagi-- reuptake inhibitors, antihypertensive medications, nal products to ease dyspareunia are insuficient. Never the less, there resources to enhance body image (wigs, special is a subset of women who report continued anxiety, lingerie, attachable nipples etc) should be widely depression, and concerns regarding body image, available to help the survivor reclaim her sexual self fear of recurrence, post-traumatic stress disorder, esteem. The use of minimally absorbed local vaginal and sexual problems well after treatment completion estrogen products remains an individual decision [592]. Sometimes women link prior negative sexual that requires informed consent and consultation with experiences, past sexual behavior (promiscuity, extra the oncology team [560, 599]. Several small reports marital affairs or acquisition of sexually transmitted [600] noted increased estradiol levels in women diseases) to their cancer diagnosis. Sexual well who take aromatase inhibitors and vaginal estrogen being in partnered women with breast cancer tablets. New lower dose tablets need further recurrence demonstrates substantial stress as they investigation and safety in breast cancer populations attempt to maintain their sexual lives. Survivors’ levels of amount of escape in to the systemic circulation has relationship distress, depression and age rather than the potential to interfere with aromatase inhibition hormonal levels have proved the most signiicant [575]. Non hormonal water based lubricants and variables affecting arousal, orgasm, lubrication, sat-- moisturizers remain the primary treatment. However, cancer, has conirmed maturation of epithelial cells there was no relationship between sexual function and decrease in pH without signiicantly increasing and hormonal levels including androgen metabolites serum estrogen or testosterone levels, with all [582]. The experience of chemotherapy rather than steroid values remaining in the range seen in post the resulting low hormones appeared to be highly menopausal women. Future studies are needed to problems may frequently lead to non compliance with examine the safety and eficacy of androgens in this potentially devastating result. Psychosexual counseling and possible depression and psychosis are chronic diseases and psychological therapies for sexual dysfunction treatment for long periods is needed: assessment should be offered to all breast cancer survivors with and management of negative sexual side effects is sexual complaints speciically addressing possible essential. Sexual dysfunction should be acknowledged as a common and frequent symptom of psychiatric 11. Enquiry about possible changes of sexual Comprehensive assessment of sexual function is performance including libido, arousal, orgasm, recommended given the multifactorial etiology and ejaculation, vaginal lubrication and erectile function premorbid risk factors including past dysfunction, should be made initially, before treatment is initiated. The American and the European Menopause Societies associated deterioration of communication skills recommend individual decisions dependant upon can impair personal relationships. Unfortunately each woman’s preference in consultation with patients frequently delay seeking help such that her oncologist [560, 599]. Non-hormonal water-based lubricants and Sexual interest is decreased in almost all depressive moisturizers remain a safe treatment for patients: it is a classical and frequent symptom. Zurich Cohort study highlights a double prevalence of sexual dysfunction in depressed patients compared with controls (50% vs.
A high number of ex- servicemen are affected by this through a combination of alcohol abuse and the reaction to the psychological trauma makes it difficult for families to cope and they end up homeless (Busuttil, 2010). Prison leavers are also a group who feature high in the data on the homeless, with 34% of London’s rough sleepers having been in prison. Some of their problems are due to their lack of accommodation prior to imprisonment, some due to losing tenancy whilst in custody and for others due to loss of family contact as a result of their crimes (Social Exclusion Unit, 2002). Immigrants are also at risk (Edgar & Meert, 2006) through their precarious working conditions as outlined above or through arriving in a country without accommodation or support being available. In some countries, illegal immigrants constitute the greatest proportion of those sleeping rough or using overnight shelters, the majority of whom are male. This support is not only crucial in preventing them ending up on the street but also in enabling them to get out of the situation they are in, in particular to find a job and to avoid becoming marginalised in society” (Eurostat, 2010a, p 179) 81 Services are being set up to cater for homeless men (see for example McCullagh, 2010) but these are limited, with many countries having no specific assistance for men or programmes in place to help prevent men who are at risk of homelessness or are on the streets already. Disability comes in many forms and men are seen to have high levels of accident and work related disability. For instance it is estimated that about 7% of European workers have some form of work related hearing problem. With the changes in modern warfare and improvements in battlefield health care there are a significant number of young men returning from conflict with severe disabilities. Improvements in the care of the young disabled have resulted in a growing number of men entering adulthood with profound physical and learning disabilities. In addition to these men with very special physical and emotional health needs there are a much larger cohort of men with mild to moderate learning difficulties trying to negotiate themselves through an increasingly complex society (Cambridge & Mellan, 2000; Elliott at al. Oxford, Radcliffe Publishing Cambridge P, Mellan B (2000) Reconstructing the sexuality of men with learning disabilities: Empirical evidence and theoretical interpretations of need. Disability & Society 15:293-311 Carballo M, Boup M (2005) International migration and health A paper prepared for the Policy Analysis and Research Programme of the Global Commission on International Migration. Polity Press, Cambridge Council Directive (2010) European Commission available at: http://eur- lex. European Agency for Safety and Health at Work, Luxembourg, Office for Official Publications of the European Communities Edgar B, Meert H (2006) Fifth review of statistics on homelessness in Europe European Federation of National Organisations working with the homeless. Luxembourg: Publications Office of the European Union 83 Eurostat (2009b) Reconciliation between work, private and family life in the European Union. Luxembourg: Publications Office of the European Union Eurostat (2010a) the Social Situation in the European Union 2009. Luxembourg: Publications Office of the European Union Eurostat (2010b) Combating poverty and social exclusion. Luxembourg: Publications Office of the European Union Flash Eurobarometer (2007) Young Europeans: survey among young people aged 15-30 in the European Union. Frosh S, Phoenix A, Pattman R (2002) Young masculinities: understanding boys in contemporary society. Basingstoke, Palgrave Gatherer A, Moller L, Hayton P (2005) the World Health Organization European health in prisons project after 10 years: persistent barriers and achievements. Houndmills Basingstoke, Palgrave Macmillan Johnson S, Jones A, Rugg J (2008) the Experiences of Homeless Ex-Service Personnel in London Centre for Housing Policy. Global Programme on Evidence for Health Policy Discussion Paper Number 50 McCullough A (2010) Young runaways and adulthood: a difficult transition. J Organiz Behav 31:45–64 Randall G, Brown S (1994) Falling Out: A Research Study of Homeless Ex- Service People. London, Crisis Seiffge-Krenke I (2010) Predicting the timing of leaving the marital home and related developmental tasks: parents’ and children’s perspectives. London, Social Exclusion Unit Social Exclusion Unit (2002) Reducing re-offending by ex-prisoners. Men and Masculinities 4(3):258-285 Stephens J (2002) the mental health needs of homeless young people. London, the Mental Health Foundation Walmsley R (2009) World prison population list (8th edn). London, International Centre for Prison Studies Wilson B, Stuchbury R (2010) Do partnerships last? Oxford, Radcliffe Publishing Woodall J (2010b) Control and choice in three category-C English prisons: implications for the concept and practice of the health promoting prison. Higher than advised salt and other mineral levels adds to the negative health consequences of men’s diets. From childhood onwards the lifestyles that many men develop are building up problems for their future, whether it’s smoking, excess alcohol intake, illicit drug use, poor diet or limited physical activity the effect is seen in their high rates of premature death and chronic morbidity. Young men feel they are living invulnerable lives, able to eat, drink and take risks without fear of the consequences; sometimes the reality is immediate, through the sudden death of alcoholic poisoning, or it may be cumulative effect as in the rising incidence of ischemic health disease or cancer in their early adult years. The risks men face are not only the consequence of the life choices they take, there are anatomical and physiological, social and environmental, and service provision factors that can compound the problems. An instance of this relates to the health problems men have when they are overweight, which are a complex blend of the availability of the right food, a socialisation process of boys with regard to their body size and their diet, an increasing sedentary lifestyle coupled with the male form of obesity comprising central (or visceral) fat deposition increasing the risk of the metabolic syndrome and the fat related cancers. This is then linked to the tendency for weight-loss health promotion and services being focused onto women. There is difficulty in agreeing the extent of sexually transmitted diseases, but it is apparent that the number of cases is increasing. However the targeting of men with regard to Chlamydia is showing that if the screening is done appropriately then men will engage. Understanding men’s lifestyles is a significant factor in the development of health strategy aimed at supporting men to lead less damaging lives. It is, however, crucially important to understand that lifestyles are not simply the product of individual choice. Across and within Member States that those who are in poorer material and social conditions eat less healthily, exercise less, consume more alcohol and are more likely to smoke or misuse drugs. In the context of addressing premature mortality rates among men, there is a growing awareness of the need to target lifestyle modification early in life among those men engaged in damaging health behaviours (White & Holmes, 2006). It has been estimated that 15% of all deaths in the European Union-including 25% of all cancer deaths - could be attributed to smoking (Directorate General for Health & Consumers, 2010). Every year, over half a million Europeans die prematurely because of tobacco use or exposure to environmental tobacco smoke. In addition to the loss of human life, smoking-related deaths and illnesses impose enormous economic burdens - over ˆ100 billion per year. Although use of smokeless tobacco does not appear to increase the risk of respiratory diseases, it may increase the risk of some cancers - particularly oropharyngeal cancers (Lee & Hamling, 2009; Weitkunat et al. The most obvious of these are cancers of the respiratory system, but there is also an increased risk of cancers of the stomach, pancreas, liver, renal system, and bladder. Smoking is also a major risk factor for coronary heart disease and cerebrovascular disease. Because men are more likely than women 89 to smoke on a daily basis, they are more likely to experience a range of smoking-related illnesses. For example, mortality rates for chronic obstructive pulmonary disease are two to three times higher for males than for females (European Respiratory Society, 2003). Similarly, mortality rates for cancers of the respiratory system are markedly higher among men, but rates are falling among men at the same time as they are rising in women. Across Europe, men are more likely than women to have ever smoked tobacco and to be current smokers (European Commission, 2009). One Eurobarometer survey of over 25,000 people in 28 countries revealed that 63% of men had smoked tobacco at some point in their lives, compared to 45% of women (European Commission, 2009). The same study revealed that men were considerably more likely to be smokers (32% vs 21%). Indeed, in several countries girls are more likely than boys to smoke (Hibell et al. Although men are more likely than women to smoke, it is important to acknowledge variability in smoking prevalence between men in different countries and among men within the same country. The proportion of men who smoke on a daily basis ranges from a low of 17% in Sweden to a high of 51% in Latvia (Fig 1. In some countries half of the male population smoke; in others only 1 in 6 men do so. When daily smokers and occasional smokers are combined, the proportion of men who smoke ranges from a low of 27% in Finland to a high of 56% in Latvia. In four countries - Slovenia (56 %), Lithuania (55%), Bulgaria (51%), and Estonia (51 %) the majority of men are smokers. In all but one of these 29 countries for which valid data were available, men were more likely than women to be daily smokers. Although men are more likely than women to be smokers, there is wide variation in the ratio of male-to- female smokers, from 1:1 in Sweden to 4:1 in Portugal (i.