Health Issues is a general health based blog concentrating on multiple health topics.

HISTORICAL AND POLITICAL ATTITUDES TO FERTILITY – OVERPOPULATION

Tuesday, April 7th, 2009

The decision to have a child must be the most fateful a person ever makes, involving as it does the creation of a new human being. Until comparatively recently in human history (the last 200 years), greater concern has been focused on fertility and the ability to have children to ensure the continuity of the human race, rather than the prevention of pregnancy. It is easy to lose sight of this historical legacy in the face of the problems to do with overpopulation. The barren woman unable to have children has always had a negative image. Thus the emphasis was on the ability to conceive. Fertility rites, spring festivals and the ancient fertility goddesses all bear witness to that (Neumann, 1955). All religions are pronatalist and anti-abortion, except in special circumstances. Couples were, and in some cases still are, urged ‘to be fruitful and multiply’, and ‘to replenish the curth’ as stated in the Book of Genesis. The purpose of sex was procreation and the gift of life was regarded as God-given. Riches were measured in the number of children a couple had, especially sons.

National governments too are involved in individual decisions about fertility. Although there are 75 countries in which the birth rate is considered to be too high, there are still 21 where there are national policies aimed at increasing the number of births (United Nations, 1990).

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DRUGS THAT RELAX THE PROSTATE: TERAZOSIN

Monday, March 30th, 2009

In a recent multi-center study, terazosin was given in various doses, ranging from two to ten milligrams daily, to more than 200 men. (Men who had “absolute indications” for prostatectomy—the conditions mentioned above—were not included in the study, and should not be considered eligible for this treatment. ) Only the men receiving 10 milligrams, the largest dose, had a significant improvement in urinary flow rate and obstructive and irritative symptoms, and the study suggested that larger doses could be given to bring about even greater results. The study proved the drug to be safe and effective in most men. It also found that some of the side effects, such as dizziness, were less of a problem if the drug was taken at night—which might be best anyway, as bedtime is often when BPH is at its most annoying. In another study, symptoms improved in 72 percent of men with BPH for at least two years of treatment with terazosin.

The change in symptoms and improvement in urinary flow with alpha blockers isn’t as dramatic as it is after prostatectomy, and alpha blockers aren’t recommended for men with severe symptoms. On the other hand, alpha blockers create fewer side effects than prostatectomy—and they’re all reversible when men stop taking the drug. One advantage of alpha blockers is that they work almost immediately, unlike finasteride, which must be taken for months before any change is noticeable. A drawback is that alpha blockers don’t change the course of BPH—they work like cold pills, just treating the symptoms, not the underlying cause of the illness. If your doctor prescribes an alpha blocker, you’ll probably be checked regularly over the first few weeks to fine-tune the dosage of the drug. Then you should be seen every few months to have your prescription refilled and your symptoms checked.

Side Effects. Alpha blockers improve urine flow by relaxing clenched smooth muscle tissue. Because their effect is not limited simply to the prostate, they may not be best for men with a history of significant heart disease or blood pressure problems. But they don’t seem to have any adverse effects on blood pressure or heart rate in men who are otherwise healthy. They are vasodilators —they open up blood vessels, making a wider channel for blood to go through, which means they reduce blood pressure. Their side effects can include dizziness, heart palpitations, lightheadedness or even fainting, nasal congestion, and fatigue, especially during the first few doses. These symptoms tend to improve over time as the body adjusts to the drug. They also seem to be diminished in men who take the drug at night.

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Tags: Erectile Dysfunction, Men’s Health
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WHEN BPH NEEDS TO BE TREATED: BEFORE OPEN PROSTATECTOMY OR TUR

Monday, March 30th, 2009

Are you in shape for surgery? Your doctor will want to check you out thoroughly beforehand. Surgery may be delayed if certain conditions, such as a urinary tract infection, need attention, or if a catheter is needed to empty the bladder. Men with urinary retention and an elevated level of creatinine in the blood (indicating impaired kidney function) must also be treated for these conditions before having a prostatectomy. When you give the doctor your medical history, be sure to say so if you’ve had any unusual problems with bleeding in the past (from dental work, for example). Also, aspirin can cause excessive bleeding; if you are taking aspirin regularly, make sure you stop at least ten days before the operation.

Another important point to discuss with your doctor: About 15 percent of men who undergo open prostatectomy need a blood transfusion during the procedure. The best blood for you to receive is your own; if your hospital allows this, it’s a good idea to donate several units of your blood ahead of time.

Shortly before surgery, your doctor may want to get a baseline evaluation of your upper urinary tract to spot anything out of the ordinary. One way of doing this is with ultrasound, which can help detect hydronephrosis (distention of the ureters and renal pelvis, caused by an obstruction downstream) and pick up any unusual masses in the kidneys. This painless, noninvasive technique will also give doctors a pretty good indication of the size of your prostate and the state of your bladder—whether there’s any residual urine there. And at the time of surgery, your doctor will probably use a cystoscope—a lighted tube, inserted into the tip of the anesthetized penis—to check for any other surprises in the bladder, such as a stone or tumor that needs to be removed.

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HELP FOR IMPOTENCE AFTER PROSTATE TREATMENT: WHAT HAPPENS IN NORMAL SEXUAL FUNCTION?

Monday, March 30th, 2009

Normal erection in men can be reduced in medical terms to a “vascular event,” but this seems too simple a description for the delicate, complex interplay between blood vessels (veins and arteries) and nerves. The penis itself is a remarkable structure, made up of nerves, smooth muscle tissue, and blood vessels. It has three cylindrical, spongy chambers that are essential to erection; one of these is called the corpus spongiosum, and the other two are called the corpora cavernosa.

When sexual function is normal, this is what happens: A man becomes sexually aroused. A substance called nitric oxide is released by the nerve endings, and the smooth muscle tissue in the penis begins to relax. The spongy chambers (also called sinusoids) within this smooth muscle tissue begin to dilate. Meanwhile, arteries continue to pump blood, as usual, into these spongy chambers of the penis. As the penis elongates, the veins are stretched; they clamp down against the thick tissue that surrounds the corpora cavernosa —shutting themselves off so the blood can’t leave the penis. The chambers become engorged, and this keeps the penis “inflated” during sexual activity. An erection is born.

After ejaculation, nitric oxide stops being released; the smooth muscle tissue contracts and the blood flow to the penis is reduced—the veins ease their viselike grip. Once again, blood is allowed to leave the penis, and the erection goes away.

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CASTRATION: SIDE EFFECTS

Monday, March 30th, 2009

Its disadvantages are certainly psychological (this can vary depending on a man’s age and stage of illness)—and cosmetic. (To help alleviate the stigma of castration, some surgeons perform what’s called a “subcapsular technique”— see above—in which only the testosterone-producing parts of the testicles are removed, and the outer shell remains. Also, testicular implants—which make the testicles appear normal—are available for some men.)

Castration is irreversible, and for many men, this is too final a treatment. In one 1989 survey, only 22 percent of prostate cancer patients opted for surgical castration; 78 percent of these men chose alternative hormonal therapy (they picked LHRH analogs, discussed in this chapter).

Testosterone is the hormone that makes men feel “manly.” When it is missing, some of the characteristics associated with being male vanish along with it. Side effects of castration—surgical or medical—can include tenderness, pain or swelling of the breasts (this is called gynecomastia), and loss of sex drive. Impotence is not an absolute certainty; 10 percent of men do remain potent. However, they are rare exceptions to the rule. (Impotence here, unlike impotence in other situations, means loss of libido as well as the ability to achieve an erection.)

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EXTERNAL-BEAM RADIATION TREATMENT FOR PROSTATE CANCER: RESULTS

Monday, March 30th, 2009

It’s difficult to show any real differences between the results of radiation and radical prostatectomy, if you look at overall fifteen-year survival rates of men with prostate cancer after both treatments. A large study from Stanford reported an overall survival of 50 percent, fifteen years after treatment, for men with stages T1a and T1b (A1 and A2) disease. From these statistics, radiation therapy looks highly promising. However, most of the patients who are initially diagnosed with localized prostate cancer who die during the first fifteen years after any form of treatment die from other causes—so studies of overall survival don’t always reveal the whole story.

Other studies of radiation therapy use different measuring slicks—prostate biopsies and PSA tests. Depending on how many biopsies are taken, anywhere from 30 percent to 90 percent of men who have received external-beam radiation therapy can have a positive biopsy two years or more after treatment. Although this does not mean that allot these men will have treatment failure— that their cancer will come back—long-term follow-up studies have found that many patients do. At five years after treatment, only 25 percent of patients will have low or undetectable levels of PSA. At ten years, only 10 percent will. However, despite the fact that PSA may be measurable, many of these men have not yet demonstrated any clinical signs of treatment failure (urinary tract obstruction, for example); these findings suggest that radiation therapy can effectively control local symptoms from prostate cancer in many patients. And frankly, for many older men—a 75-year-old man who gets radiation today, for example—it isn’t going to matter too much if PSA rises slightly ten years from now, if the therapy has controlled the cancer.

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HOMOSEXUAL OFFENDERS VS. CHILDREN: CRIMINALITY

Friday, March 27th, 2009

A fair number—about one fifth—of these offenders had juvenile records. However, a relatively large proportion of their juvenile offenses were serious, since 17 per cent ended in imprisonment for six months or more. In this they exceeded the prison group, of whom nearly one quarter had juvenile convictions and 16 per cent had sentences of six or more months. Technically one should not speak of juvenile “convictions” or “sentences,” but in actuality this is what they are, though under other labels. The homosexual offenders vs. children had the third (and nearly the second) largest number with records of juvenile sex offenses—10 per cent.

There is nothing unusual about the rapidity with which these men acquired their convictions as adults. About one quarter had been convicted of some crime by age eighteen, one third by age twenty, one half by twenty-three, and three quarters by thirty. This record lags behind that of the prison group. However, in convictions resulting in imprisonment for a year or more, essentially felony convictions, these offenders catch up with the prison group by age thirty and subsequently surpass it. This is because of their sex offenses, which are chiefly felonies; they have a higher per capita felony conviction than the members of the prison group.

The average (median) age of the homosexual offender vs. children when first convicted for any offense was twenty-four—a moderate age. His first conviction for a homosexual offense against a child came when he was thirty, the same age as the homosexual offenders vs. minors.

The ratio of sex-offense to nonsex-offense convictions, 53 per cent vs. 47 per cent, is in no way unusual and is quite similar to that of the homosexual offenders vs. adults and several other groups. Nor is the proportion of “pure” sex offenders, 54 per cent, remarkable.

The number of convictions per capita is large—4.03, a figure exceeded only by the aggressors vs. children and by the two notorious “repeaters,” the peepers and exhibitionists. However, the size of this figure is not due to sex offenses (the 2.15 per capita sex-offense figure is moderate) but to predilection for vagrancy-disorderly conduct convictions, in which they rank second with nearly one apiece. Indeed, these account for nearly half of their nonsex offenses, the largest proportion of any group. The other types of crime were correspondingly unimportant in terms of percentages, and offenses against the person were quite infrequent.

Examining now the sex offenses other than those against male children, we find that the homosexual offender vs. children favored male minors (52 per cent), to a lesser degree male adults (16 per cent), and to a still lesser degree females (14 per cent). Other sex offenses were numerically unimportant. In brief, these men were rather specialized in their sex offenses; 87 per cent of them were homosexual offenses.

Their recidivism rate was moderate, slightly higher than the prison group’s.

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INCEST OFFENDERS VS. MINORS

Friday, March 27th, 2009

Incest offenders vs. minors are adult males who have had sexual contact with their daughters or stepdaughters aged twelve to fifteen inclusive at the time. As in all incest cases, the element of force or duress is clouded by parental status and must be treated as a subtopic rather than employed as a criterion for a major sex-offense category.

The incest offender vs. minors differs from the incest offender vs. children in having been exposed to a sexual temptation more understandable to the average man; for unlike a child, girls from twelve to fifteen are often close to physical maturity and in the eyes of many are on the threshold of sexual acceptability. In brief, the hypothetical average man would be inclined to regard the incest offender vs. minors as entitled to some, albeit small, sympathy—especially if the girl were a stepdaughter rather than a genetic daughter.

In their own defense, the incest offenders vs. minors are especially prone to emphasize the physical maturity of their daughters. Like offenders vs. children and aggressors vs. children, they may occasionally add a year or two to the girl’s age. In view of the crushing disapprobation directed against offenders vs. minors, their attempt to minimize their offense is quite understandable. Another mitigation not infrequently claimed is that the daughter instigated or appeared receptive to the sexual contacts; this will be analyzed subsequently in detail.

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HETEROSEXUAL AGGRESSORS VS. MINORS: MARRIAGE; EXTRAMARITAL AND POSTMARKAL COITUS

Friday, March 27th, 2009

A little over half of our sample of aggressors vs. minors had married prior to being interviewed, not a small proportion considering that they are our youngest group of offenders. The average aggressor vs. minors married earlier than the average member of any other group—to be specific, at age 20.5 years.

Of all our groups, they had the most unstable marriages. They are the only group in which fewer than half of the ever-married men had married only once. Evidently only their youthfulness and the consequent limitation of time had prevented them from making a record for even larger numbers of marriages. Naturally, they are notable not only for multiple marriages but for the brevity of their marriages. They rank first among those with one broken marriage of two years or less, and fourth with two or more equally brief marriages.

In the light of all this, it comes as no surprise to find that the aggressor vs. minors had by far the shortest acquaintance with his future wife—in fact, he had known her for less than two months. This short acquaintance was no handicap to him in having premarital coitus with her: 86 per cent did, the largest proportion of any group. The relatively short time between the beginning of coitus and marriage prevented any large number of pregnant brides. It is worth noting that despite the brevity of his marriages the aggressor vs. minors had a moderate number of children (18 for every ten aggressors vs. minors).

Once married, the aggressors vs. minors were inclined toward lengthy precoital play. Over one third (second only to the aggressors vs. adults) habitually devoted half an hour or more to petting prior to marital coitus. For the majority, this included mouth-genital contact —indeed, 43 per cent (second in rank-order) experienced both fellation and cunnilingus. The unusual interest in mouth-genital contact typical of aggressors vs. minors and adults exhibited before marriage carried over into marriage.

Since a high incidence of mouth-genital contact in marriage usually is indicative of liberal sexual attitudes, it follows that a very large proportion of the aggressors vs. minors used coital positions other than the conventional male-prone female-supine. Also a moderately high number (17 per cent) had had anal coitus with their wives.

We cannot determine whether the high incidence of premarital coitus with fianc?es and the hasty marriages indicate that the aggressors vs. minors were marrying females who were above average in sexual responsiveness. We can, however, state that on the basis of their husbands’ reports these wives were second only to the wives of the peepers in orgasmic responsiveness; in over three quarters of the years of marriage they reached orgasm nine times out of ten or better. Such unusual response coupled with the typical tendency of the aggressors to misjudge their female sexual partners makes us feel that these reported data are biased.

Obviously this allegedly good sexual adjustment did not counterbalance the maladjustments that plagued the marriages of the aggressors vs. minors. In fact, these offenders reported the fewest happy marriages of any group. About a fourth (the next to fewest) of their years of marriage had been very happy, whereas 41 per cent (the largest proportion recorded) were very unhappy.

In accord with their attitudes about coitus, some 79 per cent of the aggressors vs. minors had extramarital coitus (the third highest percentage), which is far above the 47 per cent of the control group. These men with such coitus had it with a greater number of partners (12) than the men of any other group.

There were too few separated, widowed, and divorced individuals to permit calculation of postmarital statistics.

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