Improving Your Sex Life

Revive Her Drive

Be ready to go through a complete transformation in the way that you think and feel about having sex with your wife or girlfriend! Revive Her Drive is like a Cheat Sheet to woo your woman the way she secretly wants you to, and simply cant express. The solution is based on female-friendly, easy-to-learn strategies that she will love! How nice will that moment be when shes lying in your arms, happy and spent, and she actually Thanks You for helping her to rediscover her sensual self? Shell be grateful that you, Her Man, now that you have the vision and skill to guide her into new, electrifying experiences even if she fights you or resists you now. Women Are sensual creatures. We women want pleasure, intimacy, connection, sensation as much as you do! Ill prove this to you. Once you know how to captivate her, you can turn her into a pleasure-seeking device within 24 hours. Getting that kind of responsiveness is the feedback you need to feel confident this program is working. Discover how Robert rekindled his relationship with Lauren using the tools within Revive Her Drive by watching this short presentation that lays out the whole strategy youll use to transform your intimate life into one of passion, surrender and fantasies-come-true. Read more...

Revive Her Drive Summary


4.8 stars out of 56 votes

Contents: Ebook
Author: Tim and Susan Bratton
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My Revive Her Drive Review

Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the writer was capable of presenting advanced techniques in an extremely easy to understand language.

All the modules inside this book are very detailed and explanatory, there is nothing as comprehensive as this guide.

Sexual Intercourse Andthe Cardiovascular System

Normal sexual intercourse with orgasm is accompanied by transient but brisk physiological changes, e.g. tachycardia of up to 180 beats min, with increases of 100 beats min over less than one min, can occur. Systolic blood pressure may rise by 120 mmHg and diastolic by 50 mmHg. Orgasm may be accompanied by transient pressure of 230 130 mmHg even in normotensive individuals. Electrocardiographic abnormalities may occur in healthy men and women. Respiratory rate may rise to 60 min. Such changes in the healthy may reasonably be thought to bode ill for the unhealthy (with hypertension, angina pectoris, post myocardial infarction). Sudden deaths do occur during or shortly after sexual intercourse (ventricular fibrillation or subarachnoid haemorrhage), usually in clandestine circumstances such as the bordello or the mistress's boudoir, or when the relationship is between an older man and a younger woman although this may just reflect reporting bias in the press. In one series, 0.6 of all...

Sex Differences In Neural Correlates Of Orgasm

A parallel with the differential roles of the amygdala in male appetitive (precopulatory) versus consummatory (copulatory) sexual responses highlighted in previous animal studies is suggested by a PET study of brain activity in men during consummatory sexual behavior elicited by tactile stimulation by a female partner (Holstege et al., 2003). Relative to a resting baseline, consummatory male sexual behavior (erection and orgasm) elicited decreased activity in only one brain region, the amygdala, bilaterally during erection and in the left amygdala during orgasm. Thus, whereas viewing appetitive sexual stimuli by males in the Hamann and colleagues (2004) study elicited highly localized increases in amygdala activation, consummatory sexual behavior elicited correspondingly focal deactivations in the amygdala. In contrast to the neuroimaging studies of responses to visual sexual stimuli, where no areas of greater activation were found for females, a recent PET study of brain activation...

Historical References

A specific role for the medical expert as a provider of impartial opinion for the judicial system was identified clearly by the Justinian Laws between 529 and 564 ad. Traill (2) states that Medical Jurisprudence as a science cannot date farther back than the 16th century. He identifies George, Bishop of Bamberg, who proclaimed a penal code in 1507, as the originator of the first codes in which medical evidence was a necessity in certain cases. However, the Constitutio Criminalis Carolina, the code of law published and proclaimed in 1553 in Germany by Emperor Charles V, is considered to have originated legal medicine as a specialty expert medical testimony became a requirement rather than an option in cases of murder, wounding, poisoning, hanging, drowning, infanticide, and abortion (1). Medicolegal autopsies were well documented in parts of Italy and Germany five centuries before the use of such procedures by English coroners. The use of such expertise was not limited to deaths or to...

Adult Patients Who Are Incompetent

Since the implementation of the 1983 Mental Health Act in England and Wales (and the equivalent in Scotland) no parent, relative, guardian, or court can give consent to the treatment of an adult patient who is mentally incompetent (16). The House of Lords had to consider a request to sterilize a 36-yr-old woman with permanent mental incapacity and a mental age of 5 years who had formed a sexual relationship with a fellow patient. The court held that no one, not even the courts, could give consent on behalf of an adult who was incompetent. (This is because the 1983 act removed the parens patriae jurisdiction of the courts in England and Wales those jurisdictions in which courts retain parens patriae powers retain the ability to provide consent in such circumstances.) However, the House of Lords made clear that doctors could act in the best interests of their adult patients who are incompetent by treating them in accordance with a responsible body of professional opinion (i.e., in...

Medical and Sexual History

When children are examined, the parent or caregiver should provide comprehensive details of the past medical history. When adults are examined, only relevant medical and sexual history should be sought because confidentiality cannot be guaranteed. What constitutes relevant medical history must be determined on a case-by-case basis by considering the differential causes for any medical findings and the persistence data for the different sexual acts.

Anogenital Examination

Whenever there is a clear account of the alleged incident, the anogenital examination should be tailored to the individual case (e.g., if an adult complainant only describes being made to perform fellatio, there is usually no indication to examine the external genitalia). However, in some cases, the complainant may not be aware of the nature of the sexual assault. Furthermore, children and some adults may not have the language skills or may feel unable to provide a detailed account of the sexual acts at the initial interview. In such cases, a comprehensive anogenital examination should be undertaken if the patient or the person with legal authority to consent on behalf of the patient gives his or her consent.

Prevention of Contamination

To ensure that there is no accidental transfer of body fluids or fibers between the parties who have been involved in a sexual act, each complainant and each suspect should be transported in separate vehicles and examined in different locations by different forensic practitioners.

Method of Sampling 5111 Cutting

Pubic hairs may be transferred between individuals during sexual intercourse. Exline et al. (52) studied volunteer heterosexual couples who combed their pubic hairs immediately after sexual intercourse in the missionary position. Even under such optimal collection conditions, pubic hair transfers were only observed 17.3 of the time using macroscopic and microscopic comparisons. Pubic hair transfer to males (23.6 ) was more common than transfer to females (10.9 ).

Forensic Analysis and Persistence Data

Traditionally, the detection of the enzyme amylase on vulval and vaginal swabs was considered confirmatory evidence of the presence of saliva. However, in 1992, a study conducted at the Metropolitan Police Laboratory, London, using vaginal swabs from volunteer female donors who had not participated in cunnilingus revealed high levels of endogenous amylase (82). Furthermore, amylase has been specifically isolated from cervical mucus (83). Therefore, the FSS in London no longer routinely tests for amylase in such cases. Instead, DNA analysis is undertaken on the vulval and or vaginal swabs. If the assailant's DNA profile is obtained, it can be used to support an allegation of cunnilingus, although, obviously, the precise interpretation will depend on whether the complainant was subjected to other sexual acts that could account for the presence of the DNA (e.g., ejaculation). There are no published persistence data regarding the maximum time it is possible to obtain the assailant's DNA...

Why Is My Husband So Angry

Elmer is illustrative of some of the far-reaching consequences that a partner's chronic pain problem can have on the health and well-being of the spouse. Prior to the onset of backache, Mr. Elmer was apparently an easygoing man, his marriage was satisfactory, and he was on the whole a caring partner and a father. Then this patient went through what can only be described as a dramatic personality change following the onset of his back problem. He withdrew almost entirely from all family activities, and periodically engaged in verbally abusive behavior, mainly toward his wife and occasionally toward the children. His wife became very fearful of these outburst and lived in fear of him. The family was confronted with serious financial problems. Mrs. Elmer had to contend with her fear of these outbursts especially when directed at the children. When seen at the pain clinic, she had the appearance of a person under great stress. She looked emaciated, and reported that she...

Route Of Administration And Effect

With the i.v. route or inhalation much higher peak plasma concentrations can be reached than with oral administration. This accounts for the 'kick' or 'flash' that abusers report and which many seek, likening it to sexual orgasm or better. As an addict said The ultimate high is death' and it has been reported that when hearing of someone dying of an overdose, some addicts will seek out the vendor since it is evident he is selling 'really good stuff'.6 Addicts who rely on illegal sources are inevitably exposed to being supplied diluted or even inert preparations at high prices. North American addicts who have come to the UK believing themselves to be accustomed to high doses of heroin have suffered acute poisoning when given, probably for the first time, pure heroin at an official UK drug dependence clinic.

Assailant Identification

Certain forensic science laboratories are now able to extract mitochon-drial DNA from the degraded cellular material present in feces, although the value of this method of analysis in relation to sexual offenses must be considered in relation to the other sexual acts that are alleged to have occurred during the assault.

Sexually Transmitted Infections

Adult female complainants of sexual assault are at risk of acquiring a sexually transmitted infection (STI) as result of the assault (199,200). Some male complainants have also described STI acquisition after the sexual assault (170,171). In children who may have been sexually abused, there is a low prevalence of infections that are definitely sexually transmitted, although other organisms possibly associated with sexual activity may be identified (201). Therefore, STI testing should be offered when the history and or physical findings suggest the possibility of oral, genital, or rectal contact. Hepatitis B virus (HBV) can be acquired through consensual and nonconsensual sexual activity (210). Therefore, HBV vaccine should be offered to all adult victims of sexual assault (202). In children and young people, a risk benefit analysis will inform the decision regarding whether the vaccine should be offered. Human immunodeficiency virus (HIV) can be acquired through sexual activity (210)....

Pain as a Solution for Sexual Problems

The communicative significance of pain has been explored from many perspectives. In the interactional context, I have a pain has several message values. Madanes and Haley (1977) observed that such a statement could be a report on an internal state, but indeed, it could be a way of expressing dissatisfaction with sexual relations or with the husband's unwillingness to help with the children. The fact is that emergence of the pain problem in a partner can provide an honorable way out of an unsatisfactory sexual relationship. Pain is indeed a legitimate solution and a solution without guilt for terminating unsatisfactory sexual relationships. It is capable of resolving sexually related conflicts for both the well partner and the patient. The patient may simply opt out of the sexual relationship, using pain as a reason, and the well partner may equally refuse to engage in sexual activity on the grounds that sex may further aggravate the patient's pain. The following case vignettes help...

Pain Behaviors and Marital Relations

Sternbach (1974), in describing the home tyrant, noted that the tyrant is one that gets his way with the aid of a weapon and the patient's pain can be a powerful one. It can, for example, help him her to evade many responsibilities and yet save face, in that the pain patient is saying, It is not that I don't want to put out the trash (or have sex or go to work) it's that I can't , to which the spouse or partner responds, That's all right, honey. I understand.

It Is Just Not Good for

Wills, in his mid-fifties, had a very long history of migraine-type headaches. He was referred to a pain clinic when his pain worsened and the frequency increased. His marital history showed chronic discord over sexual relations. He acknowledged his great need and drive for sex, which was exactly the opposite of his wife's. Their sexual relations came to a sudden halt when on a couple of occasions, immediately following sexual intercourse, he had a major migraine attack. Mrs. Wills concluded that sex were injurious to his health and categorically refused to engage in any sexual relations. Her rationale was simple. Sex caused him more pain and it was in his interest to desist. She had no intention of contributing to his pain.

Evaluating Interpersonal Style

Sexual history (including first sexual experience) What did you learn about sex from your parents (or school, siblings, peers, television, or movies) What do you think is most important in a sexual relationship Have you had any traumatic sexual experiences (e.g., rape or incest)

Sexual Counseling of the Cardiac Patient

Cardiovascular disease is a common cause of sexual dysfunction. Patients and their partners may experience sexual problems as a result of anxiety, symptoms or sexual dysfunction. They worry about the effect of the condition on sexual activity, the effect of sex on the heart, symptoms that may occur during sexual activity and possible effects of medication. Healthcare providers may have difficulty addressing the issue but should take the initiative to bring up the topic of sexual functioning. There are several prerequisites to implementing successful sexual counseling. Environmental issues, communication issues, and confidentiality are important. Open-ended basic questions can be used to facilitate discussion and to assess patient concerns. In addition, specific questions are asked during this discussion, moving from general questions to more specific issues or problems as the counseling session continues. Health professionals are in key positions to provide this teaching and...

Trials and Tribulations of Newlyweds

The picture was further complicated by Mrs. Erikson's headaches. These headaches clearly intruded into their nurturing and supportive roles, as well as their sexual relationship, albeit to a lesser extent. In a curious way they each felt neglected by the other. Mr. Erikson's difficulty lay in the role shift from being a doting son and one of the boys to being a husband. The transition to marriage and all it implied was much less problematic for his wife. Mr. Erikson found a rather novel way of implicating the pain issue in their argument about roles and responsibilities. He observed that Mrs. Erikson never missed work regardless of the severity of the pain, but often resorted to bed upon returning home from work or on weekends. He complained that he also had a paid a price for her headaches as he was not free to come and go when she was in the throes of one of her headaches. This was an expression of sheer callousness from the point of view of his wife. How could he even think about...

Anal Fissures Tears and Lacerations

Slaughter et al. (90) described the gross and colposcopic findings in 311 females aged from 11 to 85 years who reported nonconsensual sexual acts, 55 of whom described anal contact. The majority (81 ) of the population was examined within 72 hours of the sexual assault. They found anal findings in 56 of the 55 patients who reported anal contact. The anal injuries were categorized as tears in 19 of the cases. Although elsewhere Slaughter has qualified the term tear to mean laceration (186), this was not done in this article and again means that interpretation of the forensic significance of these injuries may be limited.

The Role Of Hpvs In The Development Of Cervical Cancer 21 Biologic Properties of HPVs

-58, and a few others, belong to the high-risk group (6,23). These specific types can be detected in approx 95 of cervical cancer biopsies (6). Cancer of the uterine cervix, which is the second leading cause of cancer incidence in women worldwide, can be considered as a sexually transmitted disease, with a relationship between the onset of sexual activity, the number of sexual partners, and the prevalence of high-risk HPV positivity of histologically suspicious lesions (9). Consequently, the distinction between high- and low-risk HPV types provides a significant gynecologic criteria for the prognostic risk assessment of a diagnosed HPV infection.

Formulating Questions for Sexual Counseling

When beginning sexual counseling, start with a statement that stresses that concerns about sex and sexuality are normal after a cardiac illness. Often, open-ended questions are used to facilitate discussion and to assess patient concerns. For example, the health professional might use this statement Many people have concerns about sexual activity as part of living with heart failure. What concerns do you have This statement stresses that it is normal to have concerns, and it allows the individual to state any concerns to be addressed. This question can be used with any cardiac condition by inserting the appropriate health issue, for example heart attack or implantable defibrillator. In addition, specific questions are asked during this discussion, moving from general questions to more specific issues or problems as the counseling session continues (Table 40-4). This gives the health professional a better perspective of the issues and concerns. Evaluating usual sexual activities,...

Specific Strategies for Sexual Counseling for Selected Cardiac Conditions

It is often helpful to briefly discuss myths about sexual activity and cardiac disease to help frame the discussion. Open communication about sexuality between patient and partner is particularly important. Health professionals can model appropriate communication by including partners in sexual counseling, framing the questions and discussion with sensitivity to the personal nature of the topic, and involving the partner in care The importance of including information about return to sexual activity post-MI has been demonstrated in several studies and a few studies have specifically addressed sexual learning needs post-MI, although limited to one or two questionnaire items. In one study of the specific sexual counseling needs of MI patients, the importance and timing of 14 specific sexual teaching items were rated by patients as important to learn.2 Few studies have explored interventions for sexual counseling post-MI. Varvaro17 found that patients who received a nursing instructional...

Iga And Cervical Cancer

Cervical carcinoma has been one of the most common causes of cancer related death in women for many years. Although the mortality rates have fallen by 50 in the last three decades in developed countries, it continues to be a major gynecologic cancer in the underdeveloped countries. There were 15,700 new cases of invasive cervical cancer and 4900 deaths in 1996 46 , Lower socioeconomic status, early age of sexual activity, multiple sexual partners and smoking are considered to be predisposing risk factors. Human papilloma virus has attracted interest as an etiological agent in precancerous lesions and invasive cancer of the cervix. More than 66 types of HPV have been isolated and many of them are associated with genital warts. Protein products of HPV-16 (E7 protein) and HPV-18 (E6 protein) have oncogenic potential and have been associated with cervical cancer 84, 85 ,

The Cognitive Hypothesis

Our thoughts and beliefs about an illness lead us to choose how to behave. Therefore, to understand patients' behavior we have to examine their beliefs - to help them change their behavior we may have to encourage them to change some beliefs. For example, many people with angina believe that each attack leads to further damage to their heart. Quite reasonably they stop doing any activity likely to lead to angina and become inactive and physically deconditioned, an unhelpful reaction. Changing that specific belief is associated with patients becoming more active. Another common example is the belief that heart problems are caused by too much stress, worry, or overwork. Again the sensible action appears to be to avoid any kind of exciting or stressful situations sexual intercourse promotion at work playing with grandchildren, and so on. It is clear that this can lead to a failure to rehabilitate and, if too many pleasures are abandoned, a depressed and anxious patient and spouse. These...

Myths and Misconceptions

Myth 1 Sex and sexuality are the same. Truth The term sex is often used to refer to the sex act, whereas sexuality reflects both the psychosocial and physical aspects of intimacy. Engaging in sex can be fun, passionate, and has been called a restorative force that can be both healing and energizing.7 Myth 2 Older adults with cardiac disease are less interested in information on resuming sex. Truth Older adults have many of the same questions and sexual concerns as younger individuals. Studies with cardiac patients have shown that many older adults continue to be sexually active well into the 8th decade of life.2,8 Truth A number of studies have been conducted in order to clarify whether sexual activity poses any significant risk to cardiac patients. Based on these findings, patients should be reassured that, in most cases, sexual activity carries little risk of causing a cardiac event. Although sexual activity increases the relative risk of MI, the absolute risk remains low for most...

Sex Differences In Sexual Behavior

Why do men and women differ in this way Two main theoretical views have been proposed an evolutionary sociobiological account and a social influences account. The evolutionary account traces its lineage back to Darwin, who proposed the notion of sexual selection, whereby the sex that has the lower degree of parental investment in reproduction is more likely to engage in competition for the opposite sex. More recently, this account has been revised and elaborated by several sociobiological theorists (Buss & Schmidt, 1993 Symons, 1979 Trivers, 1972). According to this view, men, who require a lesser investment of time and resources to reproduce, should aggressively compete with other males for access to females and should have a greater ability to become quickly sexually aroused and motivated to engage in sexual activity. Visual sexual cues should be more salient to males, because they allow for rapid identification and appraisal of mating opportunities with Rather than focusing on...

Psychosocial Aspects and Quality of Life

Social and working life can also be negatively influenced as there is limitation of action, due to the fear that stress or emotions might alert the device. Others may worry about their body image or avoid exercise and sexual activity because of fears of arrhythmias and discharge of the ICD.13 In some countries, driving is even, at least temporarily, prohibited.14,15

Clinical Approach

The diagnosis of HSV infection is first suspected by clinical clues. The history may include vulvar burning, tingling, or pain. The lesions, which are shallow and eroded on an erythematous base, are painful to the touch. The gold standard diagnostic test is isolation of the virus by a cell culture or PCR. A specimen should be obtained by swabbing at the base of an open vesicle. Overt lesions that are not ulcerative should be unroofed and the fluid sampled. The cultures generally become positive 2 to 4 days after inoculation. Newer methods include polymerase chain reaction (PCR) and DNA hybridization, which have equivalent accuracy. Cultures for other sexually transmitted diseases should be obtained on examination. Women should be advised to abstain from sexual intercourse from the time of the prodromal symptoms or when lesions appear until they have re-epithelialized.

Influence of pain on social relationships

Work relationships and other social, community relationships may also be affected in terms of the roles held or the parts played in the various activities associated with these groups. Roy (1985) has given some excellent case examples of the social implications of chronic pain. These clearly and often dramatically illustrate these influences of the pain experience on social and interpersonal relationships. For example, there may be an effect on sexual relationships with a partner as the person in pain does not feel up to it or the partner does not wish to cause further pain. There may be a strong sense of loss associated with the chronic pain situation or of guilt leading to a depressive response which may interfere with sexual activity. The person may become shy and withdrawn because of the limitations caused by the pain and feel unworthy of such a physical relationship.

Roles and pain behaviour

Pain and sexual relationships A major aspect of the effect on the couples involves the sexual relationship. Many studies have reported evidence of sexual dysfunction (Maruta and Osborne 1978 Flor et al. 1987 Roy 1988). Roy (1989) suggests that there might be a pre-morbid history of sexual problems, depression or other interpersonal reasons for these problems (see also Walker et al. 1990) however, in many cases the pain itself does seem to be the cause (see Roy (1992) for a review of this aspect of chronic pain). However, Monga et al. (1998) argue that it is the level of disability and psychological distress including depression that influences the sexual dysfunction rather than the pain itself.

Sexual Transmission of HBV and HCV

In the affirmative, advice is appropriate about changing behavior and the use of condoms to protect their partners and themselves. Vaccination against HBV should be undertaken in those susceptibles engaged in high-risk sex, and, if the individual is a male homosexual, vaccination against HAV is also reasonable. HBV vaccine should also be offered to as many of the sexual contacts of individuals found to be HBsAg-posi-tive as logistically possible. Potential strategies for reducing sexual transmission are listed in Table 2. Long-term and monogamous sexual partners of HBV- or HCV-infected individuals should be tested for evidence of infection. If the index case has HBV, vaccination is recommended for the susceptible sexual partner. For the sexual partner of the index case with HCV, recommendations have been more equivocal and mostly limited to testing the partner for evidence of infection and providing information about the potential risks, so that an educated decision about the use of...

Approach To Jaundice History and Examination

Physical Exam Hepatitis

Hepatitis A vaccination is available and recommended for those at high risk, including travelers to endemic areas, persons with chronic liver disease, men who have sex with men or children who live in areas with high rates of the illness. Household or sexual contacts of persons infected with hepatitis A can be offered prophylaxis with injections of immunoglobulin.

On The Applied Side Design Of Culture

Consider the control of human populations (see Figure 14.11). Many scientists (and others) have suggested that people will eventually decimate the resources of the planet. They ask, How can we stop this explosion of humanity A behavioral approach to human fertility has already been developed. As early as 1974, Wiest and Squire reported a reinforcement analysis of the adoption of birth control methods. They analyzed how different birth control methods were related to the time of use before sexual intercourse, the frequency of use, and the sex of the user. The researchers noted that contraceptive performances that are dependent on sexual intercourse are difficult to measure directly simply because heterosexual behavior always occurs in private (Wiest & Squire, 1974, pp. 251-252). One solution suggested by Wiest and Squire is to target behavior that is reliably correlated with contraceptive behavior. For example, research may show that talking about the negative consequences of unwanted...

Diabetes and Sexual Dysfunction

While the pathophysiology of sexual dysfunction in diabetic men is relatively clear and convincing, the lack of such conviction in relation to diabetic women and their sexual dysfunction is evident. Prather (1988), in a review of the literature on diabetes and female sexuality, noted that studies concerning female sexual dysfunction were few and inconclusive. Etiology and prevalence rates were both in the domain of the unknown. Nevertheless, psychological factors were seen as dominant in the etiology of sexual dysfunction in diabetic women. An earlier review had noted that the most common sexual problems reported by diabetic women were inhibited sexual excitement, inhibited sexual desire, and dyspareunia (Newman and Bertelson, 1986). Furthermore, these authored noted that diabetic women with sexual dysfunction were more depressed, more stereotyped in their sexual role definitions, and less satisfied in their sexual relationships than women without diabetes. A later review confirmed...

Spousal Distress and

Spousal distress due to medical and psychiatric disorder in the partner is relatively common. All the major investigations pertaining to distress in the spouses of chronic pain patients so testify. Distress among many of the partners of chronic pain patients is commonly observed. Male as well as female spouses are adversely affected. The reasons for anxiety and depression in the spouses are perhaps not unduly complex. At its simplest, most of the spouses are forced into assuming greater levels of responsibility and, not infrequently, having to deal with unpredictability during intense periods of pain in their partners. Not uncommonly, quite a few spouses also develop an attitude that their partners are uninterested in sex, and in any event, sex with a sick person is undesirable. The spouse's perception that sex has a low priority for the patient may not be a major factor contributing to the deterioration in sexual activities. But it certainly is a contributory factor. Anger with the...

Pubertal Timing Effects

For boys, the research on externalizing behaviors has mostly indicated effects for early maturers, or for both early- and late-maturing boys compared to their on-time peers. For example, both early- and late maturing boys have been found to have higher rates of delinquency than their on-time maturing peers (Williams & Dunlop, 1999). Early-maturing boys have been found to be at higher risk for early onset of sexual activity and tobacco and alcohol use (Graber et al., 1997 Kaltiala-Heino, Rimpela, Rissanen, & Rantanen, 2001 Wichstrom, 2001). On the other hand, in their examination of long-term consequences of pubertal timing, Graber and colleagues (2003) found that it was the late maturers, in comparison to other men, who had elevated onset of disruptive behavior and substance use disorders during the transition to adulthood.

Approach To Adolescent Health Maintenance

Health risks to adolescents more likely are behavioral rather than caused by illnesses. Three fourths of deaths in the age group 13 to 19 years are due to four preventable causes 1) motor vehicle accidents, 2) homicide, 3) suicide, and 4) other unintentional injuries. Hence, one of the main focuses of the annual visit should be injury prevention, such as avoiding alcohol intoxication, using seat belts, and avoiding use of weapons. Other important issues to address include dietary habits, benefits of physical activity, and counseling about sexual behavior. All teenagers should be screened for eating disorders by use of a body mass index table. They should be queried about laxative use and induction of emesis. Drug use and depression should be questioned in a nonjudgmental fashion. Cancer screening in this age group consists of annual Pap smears for those who have engaged in sexual activity for 3 yr or have reached age 21 years. Annual Pap smear is then recommended up to age 30 years....

Sports Preparticipation Examination

29.3 A 17-year-old male reports that he has been sexually active with 2 female partners in the past year. He has used condoms sometimes, but not always. He is asymptomatic for anything and has a normal physical examination. Which of the following tests would be recommended to screen him for gonorrhea and Chlamydial 29.3 C. Urine for leukocyte esterase is recommended as screening for presumptive gonorrhea or Chlamydia in sexually active males. A urethral swab is more appropriate for diagnostic testing in a male who has a urethral discharge.

Premorbid Sexual Problems

For many of the couples, sexual problems do not begin with the onset of chronic pain. Many marriages are strife-ridden before the onset of pain, and it may be reasonable to assume that intimate and satisfactory sexual relations in these couples are a casualty of faulty and unsatisfactory relationships rather than of pain. One patient with a long history of headaches always regarded her husband as distant and uninvolved. He spent a great deal of time on the road, due to business. The sexual relationship between these two individuals was intermittent and never very satisfactory. Therefore it was hardly surprising that following the onset of her pain problem the sexual activities came to a complete halt. Another headache sufferer had felt mentally abused by her husband throughout their marriage, had no sense of intimacy with him, had serious doubts about whether or not she loved him, and actively avoided any sexual relationship with him. Their sexual relationship was intermittent, and...

Multiple Chioce On Breast Cancer

A 21-year-old female presents to your clinic for her annual exam. She informs you that for the last 3 months, she has felt a lump in her left breast above the nipple. She has had no discharge from the nipple. Her past medical history is nonsignificant. She has not been sexually active and is on no medication. She denies any tobacco, alcohol, or drug use. Her paternal grandmother had breast cancer in her seventies and did well with surgery and radiation. On physical exam, you feel a firm disc like lump at 12 o'clock on the left breast. It is easily delineated, mobile, and is nontender. The patient only has shoddy nodes in the left axilla. There are no unusual skin changes. The right breast and the remainder of her heart, lung, abdominal, and pelvic exam are unremarkable. What form of breast mass is she most likely to have 4. A 22-year-old woman comes to your office complaining of a white discharge from her breasts, which has been occurring for 2 months. She also states that she hasn't...

Clinical Pearls Immunizations 2017

A 16-year-old female presents for a routine well examination. She is a junior in high school and has no significant medical history. She plays on the school softball team and has a preparticipation clearance form for you to complete. She is accompanied by her mother who wants to know if her daughter should start having routine gynecologic examinations as part of her routine checkup. She states that the patient's last tetanus shot was at the age of 5 years. She received all of the routine childhood immunizations, including a complete hepatitis B series, and had chickenpox when she was 6 years old. The mother reports that there are no medical problems in the immediate family, but that one of the patient's cousins died at the age of 21 years of a sudden cardiac-death. When interviewed without the mother in the room, the patient reports to you that she is generally happy, she gets As and Bs in school, and has an active social life. She denies ever being involved in sexual activity, or...

Effect Of Malignancy Treatment On Fertility

A study that documented the late effects associated with treatment of early Hodgkin's lymphoma revealed that 43 191 men and 16 149 women had sought medical advice for infertility, while 57 191 men and 54 149 women were able to parent children. In addition, sexual activity was disrupted in 25.8 of cases.26

Newly Married Couple

Role allocation and role accountability, two essential components for effective role function, were not adequately fulfilled by our couple. Role allocation refers to deciding who does what, a task that evolves over time in newly married couples, and role accountability ensures that tasks are carried out, again through mutual accountability between couples. The Eriksons had not begun the process for these critical aspects of role function. Mrs. Erikson's headaches interfered significantly with nurturing and supportive roles. Their sexual relationship was less affected, but still not entirely satisfactory.

Synopsis Of The Novel

On return to the World State, Bernard and Lenina take Linda and John to the Bloomsbury Centre, its 4,000 rooms buzzing with the activity of turning embryos into whole predestined populations. Newly decanted babies suck down pints ofpasteurized external secretion, and the napping toddlers unconsciously listen to propaganda tapes on hygiene, erotic sexuality, and sociability. To all present Bernard presented John, the Director's son, who called him father, and Linda, his woman, who is now embarrassingly fat and old. Caught in petrified disgust, the astonished Director resigns on the spot. Everyone is curious about the savage, John, but Linda repels them. She sinks into a soma-induced trance to hide from her new reality. But Bernard revels in his new celebrity as the Savage's friend and guardian. John and Lenina go to a feelie, which John considers a base and ignoble experience. He has romantic notions of love from reading Romeo and Juliet, and having sex with Lenina would feel immoral....

Strategic Financial Factors

Other strategic issues for adolescents include the logistics of getting to care. Although adolescents are moving developmentally toward independence from their parents, they rarely have their own stable means of transportation, limiting independent access to care. For example, a sexually active teenager notices a tes-ticular mass. He takes the initiative to see his primary care physician, who orders an ultrasound to be done at the hospital across town. He is unwilling to ask his parents to drive him to the appointment because he is afraid that the mass has something to do with his sexual activity, of which they are not aware, so he does not attend for the planned scan.

Psychosocial and Supportive Care

This is a period when sexuality, intimacy, and reproduction are central. A young adult is supposed to attract a mate and reproduce. However, the young adult with cancer may feel or look unattractive, may be uninterested in or unable to have sex, and may be infertile. A feeling of impotence can pervade.

Case of Chronic Headache

Christy's illness on the family had the net effect of destabilizing a well-functioning family system. This rather stable, middle-class, well-adjusted family was seemingly coming apart at the seams. From a systemic perspective, the parental subsystem, responsible for all the executive functions such as decision making, nurturance, and support for the children and each other, was seriously disrupted, and the consequences were, at the very least, quite drastic. Every aspect of family functioning, such as role function rules by which families live communication capacity for mutual support, love, and affection the parents' sexual relationship and a safe and enriching environment for the children to live and thrive in, was compromised. Father's relationship with the children, especially with the son, went awry. The daughter showed signs of regression, and through all of this Mrs. Christy's sense of helplessness, combined with her feelings of guilt, kept increasing. We...

Choosing What to Include in Your Intake Report

Doe reports she is currently in a committed romantic relationship with a man by the name of William Mills. She notes that Mr. Mills is White, which her mother finds undesirable. However, Ms. Doe describes Mr. Mills as sensitive and supportive of her sexual hang-ups, but adds that William has a number of sexual problems himself. As Mr. Mills's problems interact with Ms. Doe's sexual anxiety, it appears that her sense of guilt is significantly increased. For example, she believes she is an inadequate sexual partner for Mr. Mills and this further ignites the mix of guilt and resentment she feels toward her mother and stepfather.

IOpiates and Affiliative Behavior

Film-induced changes were measured under two drug conditions placebo and an opiate antagonist, naltrexone (25 mg orally), which was used to demonstrate an opiate relation to the dependent variables. Naltrexone is a potent opiate antagonist that has high affinity for ORs and has no opiate agonist properties. Importantly, in humans naltrexone blocks the rewarding and tension-reducing effects of alcohol, morphine, and sexual orgasm, and the euphoric subjective effects of opioids, all of which are mediated largely by ORs (Uhl et al., 1999). It also blocks the development of vaginocervically induced mother-infant bonds in sheep, causes maternal neglect in monkeys (Keverne, 1996), blocks a preference for a novel odor or taste paired previously with morphine, and blocks the establishment of odor-mother and male-female recognition associations in rodents (Nelson & Panksepp, 1998 Panksepp, 1998).

Psychological Dependence

Psychological dependence can occur merely on a tablet or injection, regardless of its content, as well as to drug substances. Mild dependence does not require that a drug should have important psychic effects the subject's beliefs as to what it does are as important, e.g. purgative and diuretic dependence in people obsessed with dread of obesity. We are all physically dependent on food, and some develop a strong emotional dependence and eat too much (or the reverse) sexual activity, with its unique mix of arousal and relaxation, can for some become compulsive or addictive.

Chronic Pain and Sexual Relations

If the prevalence of sexual dysfunction in the general population were the result of a communicable disease, it would have been declared a major public health crisis. In a review of 23 studies of sexual dysfunction of the general population, community samples revealed a prevalence of 5 to 10 for inhibited female orgasm, 4 to 9 for inhibited male orgasm, and 36 to 38 for premature ejaculation (Spector and Carey, 1990). However, this review identified a number of methodological shortcomings related to sampling issues, such as the difficulties associated with representative samples of the different ethnic groups in the American population, and the problems related to the lack of a uniform operational definition of sexual dysfunction. Sexual dysfunction, while relatively common in the general population, is influenced significantly by aging and disease. Seagraves and Seagraves (1995), in their review of the literature on sexuality and aging, noted in both sexes that the evidence of a...

Vaccination Strategies

High-risk groups are generally defined as individuals with more than one sexual partner in a 6-mo period, and homosexual or bisexual males. Attendees at sexually transmitted disease clinics or public health clinics, and adolescents living in areas with a high frequency of teenage pregnancy, should be vaccinated. Intimate or household contacts of individuals who are HBsAg-positive also are vaccine candidates. Illicit injection drug users and patients with bleeding disorders, who are likely to receive nonrecombinant clotting factor preparations, should receive HBV vaccine. Patients with chronic renal failure are routinely vaccinated, and individuals who reside in institutions for the mentally retarded, and employees of such institutions, have been targeted for vaccination. Inmates in correctional institutions, in which injection drug use and homosexual behavior may occur, also are candidates. Health care or public safety workers (first-responders), and trainees in these fields, who are...

Epidemiology and Pathogenesis

Risk determinants for HPV infection that have been identified in various cross-sectional and prospective cohort studies include the number of sexual partners (lifetime and recent), age at first intercourse, smoking, oral contraceptive (OC) use, other sexually transmitted infections (STIs) (e.g., chlamydia and herpes simplex vi rus), chronic inflammation, immunosuppressive conditions including HIV infection, and parity (Trottier and Franco 2006). Nevertheless, in addition to sexual activity correlates, the most consistent determinant of HPV infection is age, with most studies indicating a sharp decrease in risk after the age of 30. The decrease in risk of HPV infection with increasing age seems to be independent of changes in sexual behavior, suggesting a role for immune response.

Prostate Cancer Stem Cells A Target for New Therapies

What then causes this change There are no known mutagens in prostate, although the gland will undergo proliferative changes in response to steroids and perhaps sexual activity. For example, low androgen and high estrogen levels can result in involution and prostatic remodelling. The prostate is also profoundly sensitive to infection, as shown by the frequency of prostatitis in the human population (MacLen-nan et al. 2006). The commonest result of this is an inflammatory response, with resultant cytolysis and requirement for repair (Karin 2006). Under these conditions the 'activated' stem cell is likely to accrue an advantage, and were an element of genetic instability to be present, then further changes in response to the new environment could occur. It has been suggested that the earliest such changes are observed as prostatic inflammatory atrophy (De Marzo et al. 1998 Nelson et al. 2004). The changes could be reversible, such as chromatin remodelling and methy-lation...

Risk Factors

Sexual activity* and co-infection with hepatitis B. Prevalence was also greater in patients who were divorced or separated, had incomes below poverty level, or who had 12 yr or fewer of education. Although prevalence of hepatitis C was greatest in middle-aged, African American males, neither race nor ethnicity were independently associated with infection. Likewise, the prevalence of hepatitis C was not associated with employment in the health care profession, surgery that might have included blood transfusion (hysterectomy), or higher frequency of dental visits. A large case-control study of U.S. blood donors indicated that injection drug users, sex with an injection drug user, and past history of blood tranfusion are the three greatest risk factors for hepatitis C (8). Weaker associations were found with incarceration, religious scarification, body piercing, being pierced with a bloody object, and immunoglobulin injection. In that study, drug inhalation and high number of lifetime...


Fellatio is not an infrequent component of a sexual assault sometimes occurring in isolation but occurring more frequently in conjunction with other sexual acts (6). Among the 1507 (1403 females, 104 males) sexual assault cases submitted to the Metropolitan Police Laboratory, London, during 1988 and 1989, 17 of the females and 14 of the males described performing fellatio and 31 of the males had fellatio performed on them during the sexual assault (65).


A 16-year-old female presents to your office with the complaint of greenish vaginal discharge for the past 2 months and the recent onset of lower abdominal pain. She reports that her last period was about 2.5 months ago. She is sexually active with two partners and has never used a condom or any other contraception with either. On physical examination she is not febrile with normal blood pressure and pulse. She has greenish discharge from the cervix with friability and cervicitis. There is no cervical motion tenderness. Her urine pregnancy test is positive. A cervical sample is positive for Chlamydia and negative for gonorrhea. Her rapid plasma reagin (RPR) is nonreactive and an HIV test is negative. The patient is treated with appropriate antibiotics and counseled concerning safer sex practices. You also inform the patient regarding her risk for HIV conversion, even though today's test was negative. The patient asks if you are going to tell her mother that she is pregnant and has...

Forensic Evidence

From the female genitalia because semen evidence can play a central role in identification of the assailant. The female genitalia should also be sampled if a condom was used during the sexual act (see Heading 11) and if cunnilingus is alleged to have occurred (see Heading 7).

External Genitalia

For penile penetration of the vagina to occur, the penis must first pass between the labia minora and through the hymenal opening. The apposition of the penis and the posterior fourchette in the majority of sexual positions means that this area may be stretched, rubbed, or receive blunt trauma as vaginal penetration is achieved. Lacerations, abrasions, or bruises at the posterior fourchette have all been described after consensual sexual activity, although in all these cases, the examinations were enhanced by the use of toluidine blue or a colposcope (90,128,129). Wilson (131) has also described macroscopi-cally visible hematomata of the labia with consensual sexual activity. These injuries usually heal completely without residual scarring (90).

Male Genitalia

During examination of the male genitalia, the forensic practitioner is expected to document any features that could assist with subsequent identification of the assailant, to note any acquired or congenital conditions that could make an alleged sexual act impossible, to describe in detail any injuries that could relate to a sexual act, and to retrieve any forensic evidence. Although the specifics of the medicolegal assessment of the male genitalia are case dependent, the principles of the examination, whether of the complainant or the defendant, are the same.

Penile Size

Forensic practitioners may be asked to provide evidence on the size of a defendant's penis in the flaccid state to support a hypothesis that a certain sexual act could not have occurred because of intergenital disproportion between the complainant and the defendant. However, such measurements are unhelpful because it is not possible to predict the maximum erectile size from the flaccid length, and there is no statistical support for the 'phallic fallacy' that the larger penis increases in size with full erection to a significantly greater degree than does the smaller penis (153). Furthermore, even when the erect penis is measured during automanipulation or active coition, the measurements are recognized to be unreliable (153).

Sampling Method

Data collected by the MPFSL between 1987 and 1995 (122) have shown that after vaginal intercourse, cellular material from the complainant can be recovered from the coronal sulcus (groove around the penis just below the glans) even if the suspect has washed or bathed since the offense. Swabs taken from the meatus and urethra are not suitable for microscopic assessment because some male urethral cells can be similar to vaginal cells (7). Therefore, when vaginal intercourse is alleged, two swabs (the first wet, the second dry) should be obtained sequentially from the coronal sulcus, and two additional swabs (the first wet, the second dry) should be taken sequentially from the glans and the shaft together. The swabs must be labeled accordingly, and the order in which the samples were obtained must be relayed to the scientist. The same samples are also taken if it is believed that a lubricant or condom has been used during a sexual act or if the assault involved fellatio or anal...

Medical Evidence

After consensual sexual intercourse, lacerations of the foreskin and frenulum, meatitis, traumatic urethritis, penile edema, traumatic lymphangitis, paraphimosis, and penile fractures have all been described (160163). Accidental trauma is more common when there is a pre-existing abnormality, such as phimosis (160). Skin injury may be incurred if the genitals are deliberately bitten during fellatio (160). Although the precise incidence of male genital trauma after sexual activity is unknown, anecdotal accounts suggest that it is rare to find any genital injuries when examining suspects of serious sexual assaults (164).

Data Analysis

Data analysis in general consists of two basic types graphical or numerical. Graphical analysis relies on the observation of a graphical display of the data, while numerical analysis involves the computation of one or more statistics derived from raw data. For example, I asked the students in my Human Sexuality class to record the times at which they had sex over several weeks. Eleven students (ranging in age from 18 to 51 years) provided usable data sheets, which documented 71 sexual encounters in 2 weeks. A small sample of these sheets is shown in Figure 3.2. A simple way to analyze these data is to plot the total number of sexual encounters initiated at each hour of the day for the whole group, as shown in Figure 3.3. Inspection of the figure immediately reveals the existence of a daily rhythm of sexual activity. Even though the students seemed to find opportunities for sex at practically any time of the day, most sexual acts occurred around bedtime (11 p.m. to 1 a.m.). A smaller...

Rectal Lacerations

Other, apparently rare, major complications that have been reported in adult males after penile-anal intercourse are nonperforating and, less frequently, perforating lacerations of the rectal mucosa (187,188). Mucosal lacerations are also seen in association with brachioproctic intercourse and the insertion of inanimate foreign bodies (187,188). On occasions, the injury may be fatal (187,188). Slaughter et al. (90) described five rectal lacerations among eight women who underwent proctoscopy after anal contact during a sexual assault. The relationship between the precise sexual act and the medical findings is not described.

Toluidine Blue

The same frequency of posterior fourchette lacerations has been identified by use of the stain in adolescents after consensual penile penetration and nonconsensual sexual acts (129). In contrast, adult complainants of nonconsensual vaginal intercourse and sexually abused children had significantly more lacerations demonstrable by toluidine blue staining than control groups (130), although such staining does not identify lacerations that cannot be detected using a colposcope (123). Therefore, if a colposcope is not available, toluidine blue may be an adjunct to the genital assessment of prepubertal and adult complainants of vaginal penetration (129,130). Furthermore, some centers use the stain during colposcopy to provide a clear pictorial presentation of the injuries for later presentation to juries (123). Little information is available regarding the incidence and type of genital injuries that result from consensual sexual acts involving the female genitalia. Although penile-vaginal...

The Uterus

Endometriosis, while not exclusively an uterine phenomenon, is a common clinical disorder that is often accompanied by severe dysmenorrhea (painful menstruation), painful defecation, chronic pelvic pain, and dyspareunia (pain during sexual intercourse), and thus is relevant to this discussion. It is characterized by the growth of uterine tissue outside of the uterus and has been modeled in both the rat (100) and the mouse (101), although behavioral data is only currently available in the rat (102). One uterine horn is removed surgically from animals and placed in culture medium at 37 C, where it is cut into equal-sized fragments (three to six, depending upon species and laboratory), each of which is then sutured to a blood vessel in the mesentery of the small intestine, lower abdominal wall, ovary, or all three (note that autotransplants to the abdominal wall rarely produce cysts, and only small ones when they do). Following wound closure, the animal is allowed to recover. In all...

Estrous Cycle

Animal reproduction requires the joining of male sperm with a female egg. Most female animals do not ovulate on demand, so that reproduction is possible only during the appropriate phase of the ovulatory cycle.101 Many humans restrict sexual activity to the infertile period of the woman's ovulatory cycle to prevent pregnancy (known as the rhythm method of contraception).102 103 A woman's estrous cycle like the estrous cycle of other female primates is called a menstrual cycle because the cycle lasts about a month (mense means month in Latin). However, there is nothing special about the month. As shown in Table 4.2, estrous cycles vary from 1 day in domestic fowl to 220 days in dogs. The duration of the estrous cycle bears virtually no relationship with infradian


The typical oscillation of plasma concentration of sexual hormones during the human menstrual cycle is shown in Figure 4.22. Because the average duration of the human menstrual cycle may vary from 23 to 36 days, and because most women experience a variation in the length of their own cycle (by a few days) from month to month, all data have been standardized to an ideal 28-day cycle. It is evident that plasma levels of luteinizing hormone are low except at the time of ovulation. Estradiol has a more complex waveform with a peak prior to ovulation, and progesterone peaks much later in the cycle.101 Note also that sexual behavior has a rhythmic pattern. Women who do not use birth control pills (which interfere with the hormonal cycles) initiate sexual activity with a partner more often right after the end of menstruation and at the


Deliberate prevention of fertilization and or pregnancy, usually without hindering otherwise normal sexual activity. Includes preventing sperm entry by use of a condom, a protective sheath over the penis preventing access of sperm to the cervix by means of a diaphragm placed over it manually before copulation (later removed) preventing implantation by means of an intrauterine device (IUD), a-plastic or copper coil inserted under medical supervision into the uterus and the contraceptive pill, withdrawal of the penis prior to ejaculation (coitus interruptus) is not an , effective method. Abstention during the phase in the menstrual c y cle when fertilization is likely is a further method. Use of condoms is fairly effective, with the added, advantage of reducing the , risk of infection by microorganisms during intercourse., I U Ds can cause extra bleeding during menstruation and may-not be- tolerated by some women

Lunar Rhythms

The 29.5-day lunar cycle inspired the concept of the month, which today is defined independently of the lunar cycle.200 Like the week, the month has effects on human behavior (Figure 4.32). The menstrual cycle of human females has an average duration very similar to that of a month (28 days) and could be considered a monthly rhythm. There also may be a monthly cycle in testosterone secretion of male humans that results from the modulation of male sexual activity by the menstrual cycle of their female partners.188

Anal Sphincter Tone

The forensic practitioner may be asked about the effects that a single episode or repeated episodes of anal penetration have on anal sphincter tone and subsequent continence of feces. In terms of single anal penetrative acts, partial tears and complete disruptions of the anal sphincters have been described after a single traumatic sexual act (187,188) one case was caused by pliers and the others by brachioproctic intercourse (fisting). However, it is not clear from these case reports whether the sexual practices were consensual or nonconsensual. The two patients who were described as having complete disruption of the sphincters both developed fecal incontinence. There is a case report of multiple ruptures of the internal anal sphincter with resultant fecal incontinence after nonconsensual anal penetration with a penis and fist (189).


Indentations or splits in the hymenal rim have been variously described as deficits, concavities, transections, clefts, notches, and, when clearly of recent origin, tears or lacerations (fresh and healed). In this text, the term notch will be used to describe divisions or splits in the hymenal rim. Superficial notches have been defined as notches that are less than or equal to half the width of the hymenal rim at the location of the notch, and deep notches have been defined as notches that are more than half the width of the hyme-nal rim at the location of the notch (93). Superficial notches of all aspects of the hymen have been described in both prepubertal (0-8 years) and postpu-bertal females (9.5-28 years) who have no history of sexual activity (9396). Notches ranging from 0.5 mm to 3 mm in depth were noted in the ventral half of the hymens of 35 of newborns examined by Berenson this study does not subcategorize the notches as superficial or deep. Deep notches of the anterior and...


Cardiac patients often are worried about a safe return to sexual activity. They worry about the effect of the condition on sexual activity, the effect of sex on the heart, symptoms that may occur during sexual activity, and possible effects of medication.1-3 Partners of cardiac patients also may be worried and may be overprotective. Some problems in returning to sexual activity are general to (cardiac) patients (Table 40-1), while others might be more disease specific. Return to sexual activity might be stressful for both for patient and partner, including experiences of fear, anxiety, and overprotectiveness. Table 40-1. Problems of cardiac patients and partners related to sexual activity - Inability to achieve orgasm Patients recovering from bypass surgery or other cardiac surgery may have specific concerns about pain and support of incisions during sexual activity. In addition, changes in body image due to the operation may play a role in returning to sexual activity. of sexual...

Sexual function

Some cord-injured men already in the intensive care unit ask about their ability to have an active sex life and become fathers. The erectile dysfunction in men after spinal cord injury has different characteristics depending on level of lesion, and mainly follows the pattern of bladder dysfunction. The person with an upper motor neuron lesion usually has the capacity for reflex erection by tactile stimulation. The person with a lower motor neuron lesion has loss of all erectile function. The capacity of psychogenic erection is lost in all cord-injured men with a complete lesion. Retrograde ejaculation is the rule when there is an ejaculation

Erectile Dysfunction

Erectile dysfunction (ED), the inability to achieve or maintain a penile erection sufficient to permit satisfactory sexual intercourse, is estimated to affect over 100 million men worldwide, with a prevalence of 39 in those of 40 years.6 Its numerous causes include cardiovascular disease, diabetes mellitus and other endocrine disorders, alcohol and substance abuse, and psychological factors (14 ). While the evidence is not conclusive, drug therapy is thought to underlie 25 of cases, notably from antidepressants (SSRI and tricyclic), phenothiazines, cypro-terone acetate, fibrates, levodopa, histamine H2-receptor blockers, phenytoin, carbamazepine, allopurinol, indomethacin, and possibly 3-adrenoceptor blockers and thiazide diuretics.

Alkyl Nitrites

The alkyl nitrites are volatile yellowish clear liquids that have a distinctive sweet smell. All the nitrites have vasodilatory properties and are used as a euphoric relaxant within the dance culture and to relax the anal sphincter and enhance sexual performance. The effect of inhaling the vapor, usually from the bottle or poured onto a cloth, is instantaneous and short-lived, resulting in a rush, but adverse effects, such as dizziness, flushing, tachycardia and palpitations, headache, cold sweats, and hypotension, may occur (115,116). Swallowing of volatile nitrites as opposed to inhaling them may result in severe methemoglobinemia (117).

Species development

Speciation can also occur when reproductive barriers develop. For example, when members of a population develop anatomical barriers that make mating with other members of the population difficult, a new species can develop. The timing of sexual activity is another example of a reproductive barrier. Spatial difference, such as one species inhabiting treetops while another species occurs at ground level, is another reason why species develop.

Hymenal Laceration

There is little specific information available regarding the type and frequency of acute hymenal injuries after consensual sexual acts, particularly regarding the first act of sexual intercourse. Slaughter et al. (90) conducted colposcopic examinations of the genitalia of 75 women who had experienced consensual vaginal intercourse in the preceding 24 hours. They found lacerations (tears) with associated bruising at the 3-o'clock and 9-o'clock positions on the hymen of a 14-year-old and bruises at the 6-o'clock and 7-o'clock positions on the hymens of two other females (aged 13 and 33 years). No other hymenal injuries were detected. Unfortunately, no details regarding previous sexual experience are recorded on their pro forma. In the same article, the hymen was noted to be one of the four most commonly injured genital sites among 311 postpubertal complainants of nonconsensual sexual acts. The hymenal injuries detected colposcopically were bruises (n 28), lacerations (n 22), abrasions...

Sexual Counseling

Health professionals must take the initiative to bring up the topic of sex with the cardiac patient. Often, the patient may feel too embarrassed to ask questions about such a private area. By bringing up the topic, health professionals are acknowledging that sexual concerns are both normal and common for cardiac patients. Health professionals must be aware of their own biases in regard to sexuality, and be careful to approach sexual counseling in a non-judgmental way. Drench and Losee15 provide a helpful guide for self-assessment of feelings and attitudes, particularly toward sexuality in older adults (Table 40-3). When I think about sex, do I think it is limited to sexual intercourse Does sex also include touching, stroking,and fondling Do I think orgasm has to occur with sex What would I think if my widowed parent engaged in sex without being married Do I feel comfortable talking about sex to adults of both genders There are several prerequisites to implementing successful sexual...

Changes in menopause

Widespread testing by Papanicolaou (Pap) smear has contributed to a significant drop in the incidence of invasive cervical cancer. Careful technique to ensure sampling of endocervical cells at the squamocolumnar junction and use of accredited laboratories to interpret smears improve accuracy of the test. Screening should begin at age 18 or with onset of sexual activity. Recommendations about frequency of testing are undergoing revision. Annual testing until age 65 has been common, but does not appear to improve detection compared to longer intervals. A number of professional organizations recommend annual Pap smears for 3 years and then, if these are normal, less frequent testing based on clinician discretion. The U.S. Preventive Health Services Task Force recommends a 3-year interval beginning with onset of sexual activity. More frequent testing is warranted for women at increased risk those with early onset of sexual activity, multiple partners, infection with human...

Endocrine Effects

The effects of cannabis upon sexual performance are not clearly understood, and the published research available often yields conflicting results. Traditionally, high doses have been claimed to reduce libido and cause impotence, whilst more moderate intake has been associated with heightened pleasure from sexual contact (Buffman, 1982 Abel, 1981). If the drug has the ability to enhance the subjective experience of sex, then this might be due to cannabis-induced relaxation or increased tactile sensitivity. There is even less information available concerning the effect of cannabis upon human female reproductive function. In animals, cannabis can impair ovulation. Kolodny et al. (1979) studied the adverse effects of cannabis upon the human female reproductive cycle. Cannabis users had a greater proportion of cycles in which either ovulation did not take place, or in which the luteal phase was very short (38.3 ) compared to non-users (12.5 ). The duration of the human menstrual cycle was...

Important aspects

Libido is greatly subject to psychosocial influences, and removal of fear of pregnancy may permit enthusiasm for the first time. It is likely that direct pharmacological effect (reduction) is rare. There is evidence that the normal increase in female-initiated sexual activity at time of ovulation is suppressed.11


The sex producing gametes of two distinct classes (in approx. 1 1 ratio) as a result of its having sex c h romo-somes that are either partially he mi zygous (as in XY individuals) or fully hemizygous (as inXO individuals). This sex is usually male, but is female in birds, reptiles, some amphibia and fish, Lepidoptera, and a few plants. Sometimes the XY notation is restricted to organisms having male heterogamety, female heterogamety being symbolized by ZW (males here being ZZ). See homogametic sex, sex

Mitosis and Meiosis

The sex cell precursors also undergo mitosis. But when the animals become sexually active, some ot them undergo another process to produce eggs and sperm, a process called meiosis. Meiosis results in each egg or sperm cell getting only one member of a chromosome pair from each parent. In meiosis, the chromosomes do not double (to produce sets of four) before being divided between the daughter cells (eggs or sperm). And so the egg or sperm cell has only hall as many chromosomes as its parent cell. This condition is called haploid, and is symbolized as n. When the haploid (n) sperm nucleus fuses with the haploid (0) egg nucleus during fertilization, the resulting new individual zygote, soon to become embryo) is diploid (2n), with all its genes now in pairs. From this point, until it too reaches sexual maturity, all its cells will undergo only mitosis.

Getting Started

Angelfish do not breed at the drop of a hat with the first other angel to come along. They select their males, a ritualized courtship establishing a relationship that includes protecting a territory. South American (as opposed to African) cichlids in general grow up before they consider sex with one another.

Sexual Reproduction

A character is said to be sex-linked if it is determined by a genetic element occurring either (a) on an X-chromosome where the method of e x de t erm i n a t i on involves an XX XO system, or (b) on any non-homologous region of a pair of sex chromosomes where the method involves an XX XY system. Most readily detected by an appropriate reciprocal cross. In an XX XY system, if the character in question is recessive it will appear in the heterogametic sex with the same frequency (say, n) as the chromosome bearing the element hence it will appear in the homogametic sex with the square of that frequency (i.e. n2). In humans, red-green colour blindness and haemophilia are such examples. X-linked characters cannot be transmitted from father to son since a father contributes a Y-chromosome to his male offspring. A mother may be a carrier, in which case- half hwinate lo be affected DoTnTnant sex-linked -


Other vaccinations may be recommended for specific populations, although not for all adults. Hepatitis B vaccination should be recommended for those at high risk of exposure, including healthcare workers, those exposed to blood or blood products, dialysis patients, intravenous drug users, persons with multiple sexual partners or recent sexually transmitted diseases, and men who engage in sexual relations with other men. Hepatitis A vaccine is recommended for persons with chronic liver disease, who use clotting factors, who have occupational exposure to the hepatitis A virus, who use IV drugs, men who have sex with men. or who travel to countries where hepatitis A is endemic. Varicella vaccination is recommended for those with no reliable history of immunization or disease, who are seronegative on testing for varicella immunity, and who are at risk for exposure to varicella virus. Meningococcal vaccine is recommended for persons with certain complement deficiencies, functional or...

Deli nit ions

18.1 A 14-year-old female is here to see you for complaints of greenish vaginal discharge. She is sexually active with one partner and does not use condoms. You do a culture and find that she has Trichomonas vaginitis. She asks you not to tell her mom about this diagnosis or that she is sexually active. Can you keep this information from her parents


In the United States, more than I million people are estimated to be infected with HIV, with approximately 25 unaware of their infection. The highest prevalence of HIV occurs in men who have sex with other men and in IV drug users, although the occurrence in heterosexual sexual contact is increasing. African-Americans are disproportionately affected with infection, both in total numbers of cases and in development of new infections.

Adverse Effects

SSRIs have a range of unwanted effects including nausea, anorexia, dizziness, gastrointestinal disturbance, agitation, akathisia (motor restlessness) and anorgasmia (failure to experience an orgasm). They lack direct sedative effect, an advantage in patients who need to drive vehicles. SSRIs can disrupt the pattern of sleep with increased awakenings, transient reduction in the amount of REM and increased REM latency but eventually sleep improves due to elevation of mood. This class of antidepressant does not cause the problems of postural hypo

Late Effects

Sexual function has been studied extensively in survivors. During treatment and soon thereafter, approximately one-third of survivors report sexual dysfunction and or dissatisfaction with level of sexual activity. However, this effect does not seem to be permanent in the majority of cases and studies indicate the level of dysfunction returns to baseline by 3 years after completion of therapy. The sexual dysfunction of some patients at the time of diagnosis, due to testicular atrophy and to the presence of disease, must be taken into account. The complications of RPLND and ejaculation have been well documented and have decreased with improved surgical techniques.


Gonadal hormones were the first biochemicals studied in relationship to sensation seeking. The reasons for this selection were based on the gender differences (males higher than females) and age changes (a peak in late adolescence and a drop at subsequent ages) on the SSS. Testosterone has similar gender and age differences. Another finding suggestive of gonadal differences is that high sensation seekers tend to have more sexual experience with more partners than low sensation seekers (Zuckerman, Tushup, & Finner, 1976). Indeed, in males testosterone and estradiol were correlated with both SSS scores (particularly Disinhibition) and sexual experience (Daitzman & Zuckerman, 1980). Estradiol in males is produced by conversion of androgens to estradiol. The aromatization hypothesis suggests that androgens in males have their major motivational effects after conversion to estrogenic metabolites (Brain, 1983). SSS scores of hypogonadal men with low testosterone levels were compared to...

Prophylactic Vaccine

Dubin et al. (2005) compared immunogenic-ity and safety of the HPV-16 18 L1 VLP vaccine formulated with AS04 adjuvant (Cervarix, GlaxoSmithKline Biologicals) in 158 preteen adolescent (10-14 years) and 458 young women (15-25 years). The vaccine was well tolerated and adverse events were rare in both groups however, higher antibody titers were observed in preteens adolescents. They concluded that higher antibody titers in the younger group might result in longer antibody persistence and be particularly advantageous when an HPV vaccine is administered at a young age well before sexual activity. Studies by the Center for Disease Control and Prevention suggest that some adolescents initiate sexual intercourse very early, in some cases before 13 years of age. Therefore, a vaccination program beginning around 12 years of age might be the ideal. At present, there are two newly licensed vaccines recommended for adolescents

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