Infertility: ‘It’s just not happening’

July 29, 2014 2:42 pm / Leave a Comment

The urge to perpetuate oneself by having children is basic to many people. About 85 per cent of couples trying to conceive, using no birth control methods and having regular sexual intercourse, will achieve a pregnancy within a year. By definition, theinf remaining 15 per cent have some kind of problem with fertility.

Sometimes the reason for this is obvious: Anthony and Katarina consulted Caroline because they had been married for eight months and were very anxious to have a baby. Anthony and Katarina both come from very religious backgrounds, were virgins when they married and were sexually very naïve. In talking with them, it was soon evident that they had never had full sexual intercourse. Surprising, you may think, in today’s free-and-easy climate, but it does still happen. Caroline found that Anthony’s tendency to premature ejaculation and Katarina’s rather thick hymen (membrane across the vaginal opening), taken together, meant that sperm weren’t getting anywhere near where they should be. What’s more, neither partner was enjoying it much.

So the first (and often overlooked) question is: are you having sex with vaginal penetration by the penis and ejaculation of semen into the upper part of the vagina? If you are not, then that is the first step. And we’re not being trite when we say that Nature intended it to be fun! If you need help or advice about sexual technique or problems canadian pharmacy viagra, it is available from people who are trained and sympathetic — either talk to your family doctor, or see the suggestions at the end of this book.

You also need to be ‘doing it’ at the right time of the month, as Kiri and Alf found.

Kiri’s cycle was dead regular at 28 days, but when her doctor checked that she was ovulating, it became apparent that Kiri always ovulated mid-week. Now this wouldn’t be a problem except that Alf was never home mid-week — he drives trucks and was gone from Monday to Friday. Sperm survive about 72 hours, and the egg is ready for fertilisation for about 12 hours, so by Friday evening of the week that Kiri ovulated it was just too late. Kiri came up with a clever solution: she took the week off from her shop job and went with Alf. ‘It was a holiday with a difference!’ she said. It worked. Little Tess was born nine months after her parents’ trucking honeymoon.

If you have conscientiously tried the above methods, and no pregnancy has resulted, then you need to consider investigation and maybe treatment. We think it’s worth pointing out that this is a good time for both partners to talk frankly with each other about their expectations. Very sophisticated technology is now available to treat many causes of infertility. But success rates for some of these procedures are nowhere near 100 per cent. Today, more couples are also choosing to remain childless. This is a perfectly reasonable choice. Having tried for a while to conceive, and not succeeded, you both might decide not to pursue investigations. It is important, though, that any decision be mutual. If you are going to proceed, have some idea how far you want to go. Infertility treatments can be expensive, time-consuming, painful and in some cases risky, as well as possibly unsuccessful. Having some endpoint in mind from the beginning is a sensible plan.

Different Ways of Expressing Feelings

July 1, 2014 11:50 am / Leave a Comment

There are many direct and indirect ways to express feelings. The words to describe feelings are learned. Some words directly describe emotions: “I feel sad,” “I feel close,” “I feel frustrated.” Others express feelings indirectly. Cheap Viagra OnlineYou might say, “Isn’t it a nice day?” to express “I feel good today” or “All you do is spend money” to mean “I am worried about money.” The more directly you express your feelings, the more likely it is that your partner will understand and interpret your meaning correctly. Viagra Australia

You and your partner have your own emotional language, nonverbal (a smile, a glance away) as well as verbal. How do you express your feelings? How does your partner? How have you expressed feelings about sexual concerns? How has your partner? Verbally? Nonverbally? Negatively? Positively? Calmly? Dramatically? Developing healthier ways to share feelings is important and will deepen your intimacy. Learning to “read” your partner’s words and actions is part of the uniqueness of intimacy. It takes months and years of sharing experiences, explaining your thoughts and feelings, to develop a mutual emotional language.

Communicating emotions is an important skill in an intimate relationship. For most men and women, it is difficult to feel close without sharing verbally what and how you feel. Love involves sharing warm, positive, romantic feelings but also involves sharing difficult, negative feelings even when that may lead to conflict. Communicating negative feelings in a positive, constructive way can lead to emotional closeness. You can still feel loved and valued even if you are down, anxious, or had a failure experience. Love tries to provide that safe harbor amidst the storms of life.

Vulnerability Within Emotional and Sexual Intimacy

Sharing feelings is important to deepening your long-term sexual relationship. Emotional openness and the nakedness of sex are the two most vulnerable and tender aspects of committed love. During these experiences, we are most exposed. When you give and receive empathy while you are vulnerable emotionally and sexually, you communicate powerful acceptance and comfort and generate trust and love.

A Crucial Emotional Skill: Empathy

In intimate relationships, an important ideal is to feel emotionally valued and accepted without conditions, to feel unconditional positive regard from and for each other. Empathy, the skill of affirming feelings, is the glue of a deep relationship. It feels good to have your successes and strengths acknowledged, but you feel especially loved and respected when your vulnerabilities and weaknesses are accepted. To empathize with your partner, imagine for a moment that you are her. Imagine that you think and feel as she does, that you experience her reality. When you are empathic with your lover (although you may not agree with her), you offer the greatest gift: acceptance, nurturance, warmth, respect, reassurance, validation, care, patience, and appreciation. These are wonderful qualities to take into the bedroom.

Exercise: Maintaining a Physical and Sexual Healthy Body

July 1, 2014 11:47 am / Leave a Comment

This exercise asks you to do a careful assessment of your sleep, exercise, eating, and drinking patterns and honestly determine whether each component contributes positively to your physical well-being and fitness. If not, the second phase of this exercise is to establish a realistic change plan.

Part I: Taking Stock

Keep a health behavior log on a daily basis for 2 weeks to observe patterns in your health behaviors. Keep the diary under four headings:

  • Sleep
  • Exercise
  • Eating
  • Drinking (include use of legal and illegal drugs).

It is crucial that you be honest with yourself. Establish a time each day perhaps bedtime to record your health behavior for the day. Or, keep this data on your PDA, Blackberry, or laptop computer and make entries in real-time.

Sleep: record what time you went to sleep and what time you woke up, whether you slept soundly or had disturbed sleep, whether you experienced worrisome thoughts or nightmares, and how rested and calm you felt in the morning.

Exercise: record the type of exercise you engaged in, for how long, and how you felt physically and psychologically after exercising.

Eating: record both frequency and quantity of eating patterns, whether planned or impulsive; healthy vs. junk foods; and whether you enjoy the eating experience or feel negative or embarrassed about it. Eating is probably the hardest to record because by its nature eating is a more frequent behavior. Canadian health care mall

Alcohol and drugs: record your drinking and drug use. Be aware of the context— do you drink alone or socially? What are the internal or external factors that contribute to drinking too much? Is your drinking out of control? How do you feel at the time and after drinking?

Review your data with your partner or a trusted friend. What does this reveal about your physical well-being and sense of fitness? Of the four areas, which is the healthiest for you? Which is the most problematic?

If all four areas enhance your physical body and fitness, congratulations. What do you need to do in the coming years to maintain this level of physical well-being? Remaining physically fit is valuable in itself as well as contributing to a healthy sexual body.

Part II: Improving Your Health

If there are one or more areas that are problematic, how can you institute a change plan? We strongly suggest beginning the change process by scheduling a general physical examination with your medical doctor. A crucial sexual health strategy is to develop a comfortable doctor–patient relationship with a trusted physician. It’s easier to talk candidly, especially about sex, if your doctor is not a stranger. Show the physician your sleep, exercise, eating, and drinking log. The physician will probably do blood tests and other diagnostic procedures and be able to provide you with an objective evaluation of your physical health along with suggestions about health behaviors.

The next step is to change your problematic health habits. Be realistic. If problems are severe or chronic, a self-help approach will not be enough. You would be wise to seek interventions with a behavioral medicine specialist or a therapist with a mind–body approach. In utilizing cognitive and behavioral change strategies, use all the necessary resources you need to successfully address the problem and attain meaningful change. These can include your partner, friends, clergy, psychologist, books, or trusted Web sites.

Intracavernous Injection Combinations

July 1, 2014 11:33 am / Leave a Comment

Muse™ Efficacy

MUSE™ (Medicated Urethral System for Erection, Vivus Inc.) is an alternative way to deliver alprostadil to the corporal bodies. Viagra Online MUSE™ involves the insertion of the delivery catheter into the meatus and depositing an alprostadil pellet in the urethra. One of the largest studies to describe the efficacy of MUSE™ was published by Padma-Nathan et al. Notable in this study, 995/1,511 patients had in-office responses to MUSE™. Of those patients with in-clinic response to MUSE™, only 299 of the 461 patients assigned to the MUSE™ arm of the trial achieved intercourse at home.

Thus, the true success rate of MUSE™ in this large study was only 42–44%. Furthermore, of the patients who did achieve intercourse at home, only 73% of doses (2,634/3,593) were successful in achieving intercourse, orgasm, or a 10 min erection sufficient for intercourse. MUSE™ is also efficacious in men who have undergone radical prostatectomy. Costabile et al. reported a 40% rate of at home success for MUSE™ in a group of 384 men greater than 3 months post-prostatectomy.

There are many direct comparison trials between MUSE™ alprostadil and ICI alprostadil. It is both intuitive and noteworthy that despite the higher success rate of ICI, some studies show that some patients prefer MUSE™. Additionally, it has been suggested as a possible rescue medication after ICI failure.

Administration Canadian viagra online 100mg

MUSE™ is available in doses of 100 mg, 250 mg, 500 mg, and 1,000 mg.

Instructions for application include urinating before use. Residual urine in the urethra aids in dis-solution and dispersal of the medicine along the urethra. The penis is then pulled straight and held pointing up. The 3.5 cm applicator stem is placed approximately 3 cm into the urethra and the button is depressed. The applicator is moved slightly to separate the pellet from the applicator tip and the applicator is removed. The penis is kept upright and rolled between the hands to aid in dissolution and dispersal of medication. The patient is then advised to walk or stand and not to lay flat for approximately 10 min to aid in blood flow.

Side Effects

MUSE™ alprostadil had similar rates of pain to ICI alprostadil, but priapism and fibrosis were rare. Other side effects unique to MUSE™ compared to ICI were dizziness, hypotension, and sweating. These occurred at a frequency of 1–6%. Syncope occurred at a rate of <1% and urethral bleeding also occurred at a rate of 1–5%. Malegra

One strategy for optimizing erectile function in PDE5 inhibitor failures while still avoiding ICI is to combine MUSE™ with PDE5 inhibitors. The theoretical basis of this is strong as sildenafil acts to improve and sustain erections, but does not help in initiation, whereas alprostadil jump-starts erection initiation in addition to aiding in maintenance of erections. Raina et al. published a small study of 23 post-prostatectomy patients unsatisfied with sildenafil. Patient satisfaction was measured using a questionnaire. An improvement from 38% satisfaction with sildenafil alone to 76% satisfaction with combined MUSE™/sildenafil was demonstrated.

Topicals Efficacy

Compared with both oral and injection therapies, topical routes are quite attractive. Theoretically, systemic effects are minimized compared to the oral route, and it is certainly less invasive, and thus would undoubtedly be more popular than injection or intraurethral therapies.

To date, however, no sufficiently effective product exists. Topical alprostadil was combined with agents to improve skin penetration (SEPA and NexACT). Vitaros, the combination of alprostadil and NexACT, formerly called Alprox-TD, was recently denied approval by the FDA due to potential carcinogenicity. In tri-als of alprostadil with SEPA, doses of 2,500 mg alprostadil were used with a resulting 39% of patients achieving erection sufficient for penetration versus 7% of the placebo group. Unfortunately, baseline characteristics were not provided in this study. Ultimately, alprostadil/ SEPA trials were discontinued because of their apparent lack of efficacy at safe doses.

A large trial of topical alprostadil without a skin penetration enhancer was also published by Padma-Nathan and Yeager which showed a statistically significant, but very slight improvement in sexual function with topical alprostadil. This study used 100, 200, and 300 mg doses of alprostadil and achieved successful penetration rates of 57.5%, up from a baseline of 50% at the highest dose. A criticism of this study is that its high initial function rates do not adequately represent population seeking treatment for erectile dysfunction.

Topical minoxidil, nitroglycerin, and papaverine were also tested variably alone and with skin penetration enhancers, but with little success.

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