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youth is wasted on the young

From International Journal of Impotence Research

Motivations for Seeking Treatment for ED: The Woman’s Perspective

M P McCabe; H Conaglen; J Conaglen; E O’Connor

Posted: 03/29/2010; Int J Impot Res. 2010;22(2):152-158. © 2010 Nature Publishing Group

Abstract and Introduction

Abstract

There is increasing evidence that partners have a major role in treatment-seeking behavior for men with ED. This study investigated the motivations of 100 females for seeking medical treatment for their partner’s ED. Semi-structured interviews focused on reasons for seeking treatment from the female’s perspective. The themes that emerged from the data centered on the importance of sex in the relationship, with closeness and intimacy frequently being seen as more important than sex. The second major theme related to hopes that females had in relation to the medication, particularly in relation to increasing their partner’s confidence and reducing his sexual frustration. Enhancement of the relationship as well as improving the female’s own feelings of self-doubt and sexual frustration were also mentioned. The results of this study show the multi-faceted nature of the motivations that females express in terms of seeking help for their partner’s ED.

Introduction

There is a growing body of literature that shows the importance of the partner and the relationship in the treatment of ED in men.[1–7] Although a wide range of literature shows that PDE5 inhibitors (PDE5i) are very effective in restoring an erection in men with ED,[8] a large number of men do not continue with the use of these treatments for their ED.[9–11]

There are likely to be a wide range of factors that are associated with this discontinuation of PDE5i medication, or the failure to even use these medications despite their efficacy.[11,12] One particular factor that has been identified is the importance of the views of the partner.[13–15] As sexual intercourse is a shared activity, it is not surprising that the views of the partner are likely to impact both on initial use and continuation or otherwise of medical treatment for ED.

A substantial number of studies have now shown that ED is associated with both quality of life[16] and sexual dysfunction in the man’s partner.[17–20] It is not clear from these studies if the ED led to female sexual dysfunction (FSD), if FSD led to male ED, or if there were other factors (for example relationship problems) that led to both ED and FSD. However, there is evidence that treatment of male ED has a positive effect on FSD.[18,20–22] The use of a range of PDE5i medications has been shown to be associated with improvements in the female partner’s sexual function/satisfaction, as well as relationship functioning.

Cayan et al. [18] reported that all aspects of sexual functioning (except sexual desire) among 38 females whose partners experienced ED were lower than for 49 partners of men who did not experience ED. Further, after the treatment of ED, these females showed significant improvements in their sexual functioning. Chevret et al. [19] also showed that ED had a negative impact on the sexuality of female partners. Female partners (n=376) of men with ED evidenced lower levels of sexual satisfaction and sexual desire than female partners (n=345) of men who did not have ED. Even life satisfaction was lower among the females whose partners experienced ED. Similar findings were obtained by Heiman et al. [23] who found that postmenopausal females (n=85) whose partners were treated for ED (compared with 91 females whose partners received a placebo) showed improvements in their sexual function, sexual satisfaction, and treatment satisfaction. Finally, Fisher et al. [22] showed that the frequency of orgasm, sexual activity, and sexual satisfaction was lower among females whose male partners experienced ED. Females whose partners were using PDE5i medications showed a more favorable sexual experience than those females whose partners experienced ED, and were not using a PDE5i medication.

One would expect from the above studies that females whose partners experience ED would be keen to seek treatment for this condition. Consistent with this suggestion, Fisher et al. [24] found that there were high levels of agreement between men and their partners on their perceptions of ED and their communication about ED. In contrast, Mita et al. [25] found that among adult females recruited through the internet, almost half of them expressed a negative attitude toward the use of drugs for ED. However, it is important to note that it is not known if the partners of these females experienced ED, and all respondents were drawn from Japan. It is possible that the response to the use of PDE5i medication may be quite different once one’s partner is diagnosed with ED, and beyond that, prescribed and/or treated with PDE5i for the condition. Further, there may be different attitudes to the use of medication to treat ED (or even any treatment of ED) within Japanese society compared with US society.

Given the central role that females have in their partners’ treatment-seeking behavior,[26,7] it is important to obtain a better understanding of the reasons why females seek treatment. This study examined the motivation of females for seeking treatment with PDE5i therapy for their partner’s ED. The study used a qualitative approach to explore women’s motivations. The results from this study are expected to provide data that will be useful in a large-scale quantitative study.

Materials and Methods

Participants

The data for this study were drawn from a sample of 100 females from New Zealand, whose partners were experiencing ED, determined by an Erectile Function subscale score ≤20, from the International Index of Erectile Dysfunction.[27] Participants were obtained through convenience sampling through advertisements for volunteers placed in a local newspaper. Potential participants were informed that they would be taking part in a trial to determine their satisfaction with two different PDE5 inhibitors. Participants ranged from 30 to 75 years of age, with a mean age of 53 years (s.d.=8.89), and the majority were Caucasian (83%). Eighty-two percent of the females were married to their partners and had been in the present relationship from 3 months to 52 years, with a mean duration of 23 years (s.d.=14.95).

Materials

In depth, semi-structured interviews explored motivations for entering a treatment program for ED, such as the woman’s perspective on the importance of sex to the couple’s relationship, as well as questions about hopes for beginning the use of PDE5i medication, and any fears about their partners taking the medication. For example, females were asked, ‘How important is obtaining treatment for your partner’s ED, as far as you’re concerned, to you, and to your relationship?’

Procedure

The study was approved by the regional ethics committee, and all participants provided informed consent to be involved in the study. The majority of females participated in face-to-face interviews, which were digitally recorded to enable repeated review during the analytical process. Interviews lasted ~20 min. Interviews were transcribed from the digital recordings, and then coded using NVivo software version 8.[28] Coding and analysis were carried out using principles from interpretative phenomenological analysis.[29] Using this approach, transcripts were examined one by one, so that extracts could be grouped into relevant themes as they emerged. As the iterative analysis continued, themes were constantly revised and extended until no further themes could be identified, and the resulting framework accounted for all relevant extracts found within the transcripts. A second coder, external to the initial analysis, coded 10% of the interviews to ensure consistency of emerging themes. From the analysis, a number of main themes were identified.

Results

Three major themes emerged in female’s discussions of their motivation for their partner seeking ED medication. These included the importance of sex to the relationship, hopes for the medication, and worries about the medication. These themes are considered in more detail below.

Importance of Sex

Table 1 outlines the main themes in relation to the importance of sex in the relationship. A common response was that sex was not the most important aspect of the relationship. Closeness and intimacy were often discussed as being more important than sex:

Table 1. Frequencies for important of sex

Theme Frequency

Closeness and intimacy more important 31

Is part of a normal relationship 22

More important to partner than self 22

Increases intimacy and closeness 14

Part of aging 11

Nice benefit of a relationship 8

‘We do a lot of kissing and cuddling and stuff like that, I mean we are really close. We’ve been married for 35 years and we can still sit on the sofa and hold hands. Because we have such a good relationship, I think it’s what has enabled us to cope with this. I’ve been able to cope with it, and as long as I have my kisses and cuddles, I’m quite happy.’ (#83, aged 54 years, duration of relationship 35 years)

However, many females were also of the view that sex was part of a normal relationship:

‘It’s important, it’s part of who you are as a couple. It’s another way of expressing the love, the care, the enjoyment that you’ve got with that person.’ (#89, aged 54 years, duration of relationship 15 years)

Females were generally of the view that sex was more important to the male partner than the woman herself:

‘I would probably say it’s not wildly important to me—it’s very important to my partner so it’s important to me because it’s important to him. I enjoy sex when we have it and sometimes I want to really participate and sometimes I don’t—I’m not that bothered. I think at various times of the month—either side of my period—I’m usually quite wanting sex and then for the rest of the month I couldn’t give a toss but he certainly does.’ (#31, aged 51 years, duration of relationship 15 years)

A number of females indicated that they thought that sex increased their levels of intimacy and closeness with their partner:

‘I feel, I like the intimacy, to me it’s hand-in-hand with marriage, like, it makes me feel loved. I just really love the intimacy and the time, I mean, especially when you’re so busy all the time, to me, that’s our time out, together.’ (#03, aged 45 years, duration of relationship 19 years)

A number of females also noted that sex was not the most important aspect of their relationship because they believed that a decrease in sexual activity was a normal part of aging:

‘I just put it down to getting older. I mean, I don’t feel like sex as often as I used to and because we’re busy and we’re both getting older and I really just thought it was a part of aging and getting older. I mean, sex drive, my understanding of it anyway, is that it should wane as you get older or maybe it doesn’t, I don’t know. My experience is that it does for us or for me and perhaps for my partner too.’ (#32, aged 49 years, duration of relationship 30 years)

Finally, some females saw sex as being a nice benefit to their relationship:

‘I think, you know, I mean I’m not going to leave my partner because of it—because you know we’ve got a deeper situation than that. I mean that’s not why we’re together for the long term but I mean it is a nice benefit to have on tops of it isn’t it? So it is a nice plus.’ (#35, aged 51 years, duration of relationship 29 years)

Hopes for Medication

The main themes related to what the females hoped would occur as a result of using the PDE5i medication is summarized in Table 2. The themes from the female’s responses centered on how the medication would help the females themselves, their partner, and their relationship. There were a number of themes surrounding hopes for the medication that were focused on the impact of the woman herself. Examples of these three main themes of how the use of the PDE5i medication was expected to assist the females are outlined below.

Table 2. Frequencies of hopes for the medication

Theme Frequency Focus

Reduce cognitive preoccupation, increase confidence 29 Male

Reduction in partner’s sexual frustration 26 Male

Increased intimacy and closeness 23 Couple

Reduce own feelings of self-doubt 22 Female

Partner to feel more masculine 19 Male

Reduction in own sexual frustration 18 Female

To enhance the relationship 16 Couple

Reduce hesitation about becoming involved in sex 16 Female

Return to normal life 9 Couple

Determine how the medication works 8 Couple

Reduce Own Feelings of Self-doubt

‘It’s impacted I would say quite a lot, we are at the stage now where we are able to talk about it, and we’re much more open, … I sort of think, it’s me, I’m old, and you know, typical, he doesn’t fancy me any more, I’m unattractive to him, and I went through all those self-doubt things, and that was impacting very badly. We were starting to grow apart, and as I say, we decided to talk about it, and open up, and he said look, it’s got to keep reinforcing that it’s not me, it’s just a thing that’s happening, and we must work together.’ (#53, aged 52 years, duration of relationship 27 years)

Reduction in Own Sexual Frustration

‘It is very frustrating and I ended up saying ‘we have to do something, because I’m 33 years old and I can’t go on like this for the rest of my life’. And that was the trigger for him to say ‘I’ll go and do something’. He was quite nervous I guess, and I can understand that it must be difficult for a guy to suddenly go in to the doctor and say ‘I’m having problems’. Of course once the drug worked it was great and it seemed to restore some confidence, but the other thing we found was that when he could have an erection he would ejaculate very quickly, so it was all over within like 20 seconds. So again, that is very frustrating.’ (#75, aged 33 years, duration of relationship 12 years)

Reduce Hesitation about Becoming Involved in Sex

‘It was a two way thing I think, I know personally it was just that attitude, oh look, don’t even start. Because I’m not even going to try to be aroused, I got to the point where I wouldn’t allow myself to get aroused because I thought, oh damn, I don’t want to get like that, and then get so aroused, where you can’t complete the job, and I’d just be left frustrated.’ (#17, aged 49 years, duration of relationship 28 years)

There were also three main themes surrounding hopes for how the medication would help the male partner.

Partner to Feel More Masculine

‘I feel deeply for my husband because he feels a failure as a man; if there was some form of treatment that would give him his erection function back again I would be only too happy; as much as anything just for his peace of mind.’ (#27, aged 65 years, duration of relationship 47 years)

Reduce Cognitive Preoccupation, Increase Confidence

‘But of course, what happens is, being a male, even though there’s an underlying physical cause, psychologically it has a huge impact which probably compounds the whole situation even more. I think certainly from (partner)’s perspective, if by using some medication then it’s easier for him to become erect it’s certainly going to do his self-esteem and him a world of good, and hopefully he’ll be feeling less sexually frustrated, and that’s got to have positive spin-offs in the rest of our relationship.’ (#43, aged 46 years, duration of relationship 26 years)

Reduction in Partner Sexual Frustration

‘Just… he’s happier, I’m happier. He just gets so frustrated with the whole thing when it doesn’t work like he wants it to.’ (#29, aged 54 years, duration of relationship 27 years)

Finally, there were four themes that were focused more directly on the dyadic relationship and hopes for how the medication might help the couple.

Increase Intimacy and Closeness

‘Of course, the desire and the arousal depend so much on the situation, and a lot of different things come into it. And I can, in the past, I can remember being so aroused, and so full of wanting to get going, but when you kind of get into a relationship, and you’ve been together for quite a long time, things change. So I don’t feel a lot of desire now, but what I’m wanting is the closeness, and I’m wanting it for (partner), so that he can, you know, experience that again.’ (#14, aged 66 years, duration of relationship 18 years)

Return to Normal Life

‘Strangely we’re still getting on fine and we thought ‘well this is how it will be till the end of our days’, but it would be nice if it could be like it was.’ (#79, aged 66 years, duration of relationship 48 years)

Determine How the Medication Works

‘To find a product, obviously, because we’re going to have to use a product, we know that now. To find a product that’s going to suit both of us and for the side effects not to be too damaging.’ (#92, aged 49 years, duration of relationship 25 years)

Enhance the Relationship

‘I think that probably, if the sex in the relationship was right, everything else would balance out.’ (#90, aged 35 years, duration of relationship 6 years)

Worries

Table 3 summarizes the frequencies of the main worries that the females expressed in relation to their partner’s use of the PDE5i medication. There were five major themes that arose regarding these worries.

Table 3. Frequencies of worries for the medication

Theme Frequency

Side effects and health issues 29

The cost of medication 15

Not natural 10

Puts pressure on woman to perform 9

That it will take away the spontaneity 8

Side Effects and Health Issues

‘Oh only what you hear, you know, I’d hate him to drop dead of a heart attack or anything! But he’s been fairly extensively tested for his health and he’s a real physical health nut person so I don’t imagine he puts himself under any more stress than when he’s working out at the gym or walking up mountains or things like that.’ (#31, aged 51 years, duration of relationship 15 years)

Cost of Medication

‘I was going to say to you, we’re not that financial and it’s just horrendous, the cost, you know, one hundred dollars for four tablets, that’s, you know, there’s times that we just can’t get them, and we can go on for weeks or months and then I get really frustrated too, and I know (husband) does too. Because, you know, we’ve got a family, and we’ve got bills to pay, so it’s like, but then I think to myself, gosh, this is part of our life now, and you know, we need something for us as well, and I think sometimes that, I think it is important that we put money aside to try and get them, but it’s not always possible.’ (#03, aged 41 years, duration of relationship 19 years)

Not Natural

‘It doesn’t light my fire, but if it’s going to help (partner) then that’s fine with me. Because you know we had a little sample tablet and we had one and it was just, we couldn’t get over how it works. To me, I feel it’s a bit out of nature, but, one minute you can’t do it and the next minute suddenly wow! And you can do it about 1000 darn times, you know? And to me that’s just not a natural process. But if it’s going to give (partner) some satisfaction well that’s fine with me.’ (#19, aged 50 years, duration of relationship 31 years)

Puts Pressure on Woman to Perform

‘I think, if you have a pretty full-on day, really all you want is a cup of tea. ‘Oh, I’ve taken a pill’; well, it doesn’t always work that way I don’t think. Because, I think it’s going to be easier for him, having the pill, to be into it, than for me who doesn’t have a pill. I mean, he’s going to be able to perform, whereas a woman can’t always perform at that time.’ (#16, aged 55 years, duration of relationship 33 years)

That it will Take Away the Spontaneity

‘But I find with me, if he tells me he’s taken a tablet, then I don’t want it. You know, I don’t want sex. Because to me sex is something you do just out of the blue, you know? That’s where the excitement and all that comes into it. And when you think oh hell, I’ve got to do that.’ (#91, aged 48 years, duration of relationship 28 years)

Discussion

This analysis of female’s motivation for treatment revealed that a large number of the themes related to their partner’s sexual and psychological functioning. Female partners wanted the partner to feel better about himself (more confident and masculine), and through addressing his needs, they expected that there would be a flow-on effect to their own sexual and interpersonal relationship. Many of the females indicated that sexual performance was more important to their partner than to them. In fact, they were of the view that closeness and intimacy was more important to them than sexual interactions. Interestingly, many females viewed sex as being part of a normal relationship, and a number of them experienced sexual frustration if they could not have sex with their partner. As suggested by Chevret-Méasson et al.,[30] females’ satisfaction with their sex lives were improved with the use of PDE5i medication and this is a central motive for females to seek treatment for their partner’s ED. Females expressed a number of concerns about using medication for their partner’s ED. These primarily focused on the cost of the medication, the side effects, pressure on them to perform as well as the lack of spontaneity that may result from the use of the medication.

These results are useful for identifying what motivates females seeking treatment for their male partner’s ED. Earlier research has shown that treatment of male ED has a positive impact on FSD, as well as on their levels of sexual satisfaction.[18,13,22,23] This study shows that the main motives for females seeking treatment for their partner’s ED primarily center on their partner’s needs rather than their own level of s.d. The other major motive was to improve the level of intimacy and communication in their relationship. These results would suggest that the females in the study were supportive of their partner seeking help for his ED, and were likely to have a role in his treatment-seeking behavior.

The themes emerging from the data also centered on the male’s sense of masculinity and confidence. Rosen et al. [31] found that treatment of ED using PDE5i medication led to an improvement in the quality of life of treated males, and that this relationship was mediated by mood and their relationship with their partner. Overall, these results show the broader impact of treatment on the lives of males with ED, and that female partners are aware of these change. Further, females seek treatment for their partner’s ED in an attempt to achieve positive changes in their partner’s lives, as well as broader aspects of their own life.

It is important to note that the couples in this study may not be representative of the general population, in that they were all motivated to be in the study, and hence, to seek treatment. Also many of them had been in their current relationship for a long period of time. Future studies need to further explore the role that female partners have in men with ED seeking treatment for this condition. Given that so many men do not continue with PDE5i medication despite its effectiveness in treating their ED, it is important to understand the role that their partner has in initiating and continuing this treatment regime. In this way, treating physicians will have the information to enlist the assistance of partners to ensure that men seek and continue treatment for ED. Such a process is likely to improve both male and female s.d., enhance their quality of life, and improve the level of intimacy and communication in their relationship.

New Zealand is a favorite post-urologic residency destination. They have a very good urologic medical community and I have two  friends that did a fellowship there. That Mr. Tucker speaks of being sexually active  after a prostatectomy bespeaks of the folks over there performing a prostatectomy the right way ( I also noted the length of his incision on his last blog and the size of it tells me something about of his surgeon’s acumen). One of my friends that did a year over there, and by the way both told me they were treated very well by the community there and that their experience enhanced their understanding urology. The way one of my friends told it, and he was there circa 1986, they had a dinner in his honor to celebrate his time there and as appreciative send-off. At the conclusion of the ceremonies they asked him to speak and he took the opportunity to tell a joke. Now, I love jokes and have quite the repertoire myself and in a situation like this half way around the world and the likelihood that he’d never be back, one would not take the choice of “the joke ” lightly. It would have to be one that was not only thought out, but one taking into consideration the audience and one that he knew would have a positive response. A “ringer of  a joke” so to speak. This is the joke he told me he told to all the urologists in New Zealand, possibly one in the audience performed Mr.Tucker’s surgery, a budding urologist at the time so to speak. Hey, you never know. Ps… if you are a urologist in New Zealand and were in training or practice when a urologist from Georgia with the initials D.D. was visiting please let me know. Anyway without further a Dieu (apologize for spelling, I have never seen this word spelled.)

Death by A chee chee.

Three men were in a plane crash over a far-away land and captured by the natives. They were each given two options; to be boiled in the fat of dead animals and then for their skin to be used for the covering of the native’s canoes, or death by a chee chee. The first man chose “death by a chee chee.” At the announcement by the tribal leader, the natives went into a frenzy and encircled the unfortunate survivor. They then stripped him and then tortured him both to the horror of the man himself as well as the two other men watching. The next man considering his options decided that the lesser of two evils was death by a chee chee as well. The thought of frying in a vat of boiling fat far out-weighed what he had just witnessed albeit each was detestable. So again the tribal leader declares, ” He has chosen death by a chee chee!” Again, the natives go wild and the second man is encircled , striped of his clothes and tortured. When this ended, the third man was asked his decision. (Tough decisions,… a plug for the book and the prostate decision process was purely accidental.) Having witnessed the two previous men and what had been done to them, not only was he now very angry at what he had observed, he could not bring himself to ” death by a chee chee.”  The tribal leader then asks him how he would want his fate to proceed. “I want to be boiled in fat,” he says indignantly. The tribal leader states loudly, ” He no want death by a chee chee.” All of the natives are dejected and surround the last man with shoulders slumped, as the fire is stoked and the flames begin to boil the fat in a very large “human size” pot looming over the condemned man. The last man says to the tribal leader, “My I have a last wish?” Somewhat surprised but relenting the leader says, “Yes, you may.” The last of the three men says, ” I want two forks.” “Forks,” the tribal leader asks somewhat confused? ” Yes , a fork,” the man ascertains. ” Get  forks.” A member of the tribe runs off and returns with a fork, which he gives the remaining man. The whole tribe is now crowding around him smelling blood and the anticipation of his eminent death and the subsequent procurement of his skin. The last survivor takes the forks and begins to violently and repeatedly  stabbing himself all over his body as deeply and quickly as he could as the natives begin to clutch at him to stop and to get him to the pot of boiling fat.

The man then yelled, “To hell with all of you and to hell with your damned canoes!”

I am not saying it was the best of jokes, I am not saying I would have chosen it,  just that it was one he decided to tell in New Zealand when he could have told any number of jokes. He was an excellent joke teller.     I guess you had to be there.

The prostatblog by Jim Tucker

07 Jan 2010

Sexual function in prostate cancer patients receiving external beam radiation therapy (EBRT) decreases within the first two years after treatment but then stabilizes and does not continuously decline as was previously thought, according to a study in the January 1 issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Radiation Oncology (ASTRO).

Prostate cancer is the most common male cancer other than skin cancer. It can be effectively treated using multiple methods, including prostatectomy, brachytherapy and EBRT, so the long-term side effects are often used by patients and doctors as deciding factors when choosing a treatment.

Changes in sexual function are some of the more common side effects from prostate cancer treatments, but the degree to which EBRT affects function varies widely, depending on the study.

In a first of its kind study, researchers at the Jefferson Medical College of Thomas Jefferson University in Philadelphia, the Thomas Jefferson University Hospital Department of Radiation Oncology in Philadelphia and the University of California, Davis, School of Medicine Department of Radiation Oncology in Sacramento, Calif., evaluated 143 prostate cancer patients receiving EBRT who completed baseline data on sexual function before treatment and at follow-up visits.

Patients were analyzed on sexual drive, erectile function, ejaculatory function and overall satisfaction for a median time of about four years. The study authors found that the strongest predictor of sexual function after treatment was sexual function before treatment and the only statistically significant decrease in function occurred in the first two years after treatment and then stabilized with no significant changes thereafter.

“Treatment-related side effects, especially sexual function, have a significant effect on a patient’s quality of life and satisfaction with their overall outcome,” Richard Valicenti, M.D., M.A., senior author on the study and professor and chair of radiation oncology at the University of California, Davis, School of Medicine. “The results of this study allow patients and their partners to have a fuller understanding of the long-term sexual side effects of EBRT and what they can expect after treatment, which should aid in deciding on a treatment course.”

Source:
Beth Bukata
American Society for Radiation Oncology

My thoughts-

This is a good article but not for the reason that it was written. The deal is that patients are very much aware of the potential for sexual dysfunction as a result of surgery, but often don’t consider it an issue if they choose radiation. Brachytherapy (seeds) affects sexual function more than external beam and of course combination therapy of external and brachytherapy affect erections more than either alone. In the decision making process it is very important for the newly diagnosed patient to consider the ramifications of all treatments on erectile function.  As it pertains to the quality of your erections and how you void after the treatment of prostate cancer, there is “no free ride.” This issue is addressed in my book “The Decision: Your prostate biopsy shows cancer. Now what?”

Psychiatric disorders and sexual trauma in women increase the risk of lower urinary tract symptoms, such as incontinence and overactive bladder, a new study finds.

U.S. researchers analyzed the answers in two questionnaires — the Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7 — completed by 121 female veterans referred to a specialized urology clinic for evaluation of lower urinary tract symptoms. The researchers also examined the women’s mental health, history of sexual trauma, age, race and obstetric history. The women were compared to a control group of 1,298 women.

Compared to those in the control group, the women in the lower urinary tract symptoms group had higher rates of psychiatric disorders (64.5 percent versus 25.9 percent) and sexual trauma (49.6 percent versus 20.1 percent). Further analysis revealed that women who were younger than 50 and had a history of miscarriage had higher Urogenital Distress Inventory-6 scores, while those with psychiatric disorders and a history of miscarriage had higher Incontinence Impact Questionnaire-7 scores.

“This is the first study to our knowledge to characterize the association of psychiatric comorbidities and sexual trauma with the type, severity and quality-of-life impact of lower urinary tract symptoms in women using validated surveys. The prevalence of psychiatric comorbidities and sexual trauma is high in women veterans presenting for evaluation of lower urinary tract symptoms,” wrote Dr. Adam P. Klausner, an associate professor and director of neurourology, female urology and voiding dysfunction at Virginia Commonwealth University Medical Center, and colleagues.

The study was released online Oct. 22 in advance of publication in the December print issue of the Journal of Urology.

SOURCE: Journal of Urology, news release, Oct. 22, 2009

Incostress is a new medical device which controls incontinence.

Women who have been sexually abused have to cope with a double trauma. Sexual abuse is the worst intrusion a woman could ever endure. The women close up and don’t speak about it due to the stigma attached. Women carry the shame when it is NOT their fault. It leaves many scars and burdens them so much that they block out this horror until one day it is thrown back at them with a force that is harder than the punch of Mohammed Ali. Many women live in fear and the fear is exasperated when they become incontinent. Another thing they have to  hide and cope with in silence.

It is time women took their life back. Taking the first step is always the most difficult. Analysing what makes us behave in certain ways allow us to deal with and face our demons.

One group of women who have  never met face to face write out their experiences and help each other on a forum. Cheaper than speaking to a doctor and relating with other women who have experienced the same things. It is time to take control and stop hiding behind the mask.

A lot of medical conditions relate to our mental state of mind.

This is an invaluable introduction to how nutritional supplements can be used to counter those side effects that can make life miserable–or even disrupt treatment adherence–in people taking antiretroviral medications for HIV.

Read about approaches to dealing with diarrhea, nausea, heart health issues, diabetes, insomnia, fatigue, liver stress, lipodystrophy, anxiety and depression.

This FREE Guide is available online at:

http://newyorkbuyersclub.org/

On the NYBC website you can also SUBSCRIBE to the nonprofit co-op’s quarterly FREE newsletter, THE SUPPLEMENT, which continues to offer a unique perspective on current evidence-based use of supplements for chronic conditions including cardiovascular disease, diabetes/insulin resistance, hepatitis and other liver conditions, anxiety/depression, osteoarthritis, cognitive and neurorological issues, and gastrointestinal dysfunction.

If you want to be able to understand how certain types of treatment for prostate cancer (and other diseases) affect sexual function, you need to be able to define and understand the sexual functionality of couples prior to any treatment as well as post-treatment.

However, this is not something that patients or their partners necessarily greet with enthusiasm! READ MORE>

In recent years there’s been a lot of well-designed scientific research about the effectiveness of dietary supplements for depression. The supplements studied have ranged from the herb St. John’s Wort, which has a long tradition of use, to molecules like SAMe, L-Tryptophan, and 5-HTP, which play a role in the body’s production of neurotransmitters (such as serotonin) connected with mood and cognitive function. Other developments in depression research involve the steroid DHEA and fish oil.

DHEA (Dehydroepiandrosterone). In a study sponsored by the National Institute of Mental Health, DHEA was found to be an effective therapy for mild to moderate or severe midlife depression, on a par with some prescription drug treatments. Moreover, the NIMH research showed that taking DHEA promoted both a significant lifting of depressive symptoms and an improvement in sexual functioning. (On the other hand, inhibition of sexual function remains one of the chief troublesome side effects of prescription anti-depressants). Note that dosing recommendations vary for men versus women, and DHEA is not recommended for those diagnosed with prostate problems or cancer.

SAMe (S-adenosyl-l-methionine). First studied by Italian researchers in the 1950s, SAMe is produced naturally in the body from the amino acid methionine. Supplementing with SAMe increases concentrations of the neurotransmitters serotonin and L-dopamine, which are related to mood. Several studies show SAMe having an anti-depressant effect comparable to that of some prescription drugs. A dose of 400-800mg/day has been studied for mild to moderate depression, and 800-1600mg/day for the moderate to severe condition. As of 2007, SAMe was being compared with the prescription drug Lexapro® in a 5-year NIH-funded study. SAMe generally has fewer side effects than prescription anti-depressants. However, it should be avoided in people with bipolar disorder, and should be used cautiously with other anti-depressants, because the combination may push serotonin levels too high. Taking a B-complex vitamin while using SAMe can counter build up of homocysteine, which is associated with heart disease. (It’s best to take them separately.) SAMe also supports joint health and liver function, so may have positive effects for overall health if taken over the long term.

St. John’s Wort is a widely used herb with clinically demonstrated (multiple, well-controlled studies, mostly in Europe) anti-depressant effects for mild to moderate depression – generally without the side effects of prescription antidepressants. High doses of the herb may cause a sensitivity to light (phototoxicity), so avoid direct sunlight or sunbathing while using. Do not take St. John’s Wort with 5-HTP, serotonin re-uptake inhibitors (like Prozac), or with protease inhibitors, as it my affect beneficial liver enzymes. St. John’s Wort may also have activity against Epstein-Barr and herpes infections.

L-Tryptophan and 5-HTP (5-hydroxy L-tryptophan): These closely-related supplements are converted in the body to serotonin and to melatonin. (Specifically, L-Tryptophan converts to 5-HTP, which then converts to serotonin or melatonin.) Their use as antidepressants has been studied, and they have also been found to aid sleep and suppress appetite. (To minimize appetite suppression, try taking the supplement an hour before bedtime.) Mild gastrointestinal side effects have been reported with both. For best absorption, take with water or juice, and separately from protein-containing foods and dietary supplements. Although L-Tryptophan and 5-HTP are close relatives, people may respond somewhat differently to them. Thus, if encountering unwanted side effects or lack of effect from one, it may still be worthwhile to try the other.
The suggested dosage for 5-HTP is wide, ranging from 50 and 500 mg daily. It can be used together with other anti-depressants, in which case an effective dose could be quite low. The best approach is to start at the low end of the range and increase as needed. Like 5-HTP, L-Tryptophan has been used in combination with other anti-depressants, and has also been employed with lithium for bipolar disorder. An added benefit: 5-HTP may also decrease symptoms of fibromyalgia and migraine headaches.

Fish Oil. Epidemiological studies have suggested that populations that eat fish regularly have low rates of depression. More recently, research has found fish oil supplements (omega-3 fatty acids being the significant component) of benefit in treating depression and bipolar disorder. It’s also worth noting that fish oil can be taken with other anti-depressants as an adjunct therapy. Doses found effective in treating depression are quite high, 3 to 9 grams per day, so be aware of potential problems related to the supplement’s blood-thinning properties. Added benefit: as has been widely reported, fish oil can have a beneficial impact on cholesterol regulation and in supporting cardiovascular health.

References:
Christian R. Dolder, “Depression,” in Natural Products: A Case-Based Approach for Health Care Professionals, ed. Karen Shapiro, published by the American Pharmacists Association, Washington, DC (2006), pp. 97-114.
Shaheen E Lakhan and Karen F Vieira. “Nutritional therapies for mental disorders” in Nutrition Journal (2008), 7:2doi:10.1186/1475-2891-7-2. Accessed 10/7/2009 at http://www.nutritionj.com/content/7/1/2
Schmidt PJ, et al. “Dehydroepiandrosterone Monotherapy in Midlife-Onset Major and Minor Depression,” Archives of General Psychiatry (February 2005): Vol. 62, No. 2, pp. 154–62.
Hyla Cass, “Prescriptions for Depression,” in Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition. Basic Health Publications (2007), pp. 113-128.

Having excessive belly fat can lead to a number of different health conditions such as:

• Heart disease
• Stroke
• Some types of cancer
• Metabolic syndrome
• Type 2 diabetes
• Insulin resistance
• Low levels of high-density lipoprotein (HDL), also known as “good” cholesterol
• High triglycerides
• Sleep apnea

According to health specialists, a man can tell if he is carrying an unhealthy amount of belly fat if his waist exceeds 40 inches. At 40 inches, the risk of heart disease becomes far greater. To lose belly fat, Jensen recommends lowering your caloric intake, developing a light exercise routine; gradually increasing physical activity.

As Boston Medical Group often advises, a man’s sexual function relies partially on how well he takes care of his body. Eating healthily, exercising and visiting a doctor for regular check-ups is very important.  More information on weight loss and belly fat can be found at http://www.mayoclinic.com/print/belly-fat/MC00054/METHOD=print