RSS Feed

Лечение аллергии-Allergy treatment

Профилактика аллергии.

МЕРЫ ПРОФИЛАКТИКИ ПОЛЛИНОЗА: УСТРАНЕНИЕ ПРИЧИН НАРУШЕНИЯ НОСОВОГО ДЫХАНИЯ, ЛЕЧЕНИЕ ИНФЕКЦИЙ

Больным поллинозами (пыльцевая аллергия) необходимо особое внимание уделять общему состоянию здоровья, а также состоянию верхних дыхательных путей, предохраняться от острых респираторных заболеваний, так как при измененной реактивности аллергия легче присоединяется к микробным антигенам. С большой осторожностью надо принимать лекарственные препараты. Ни в коем случае нельзя самостоятельно лечиться, чтобы не вызвать повышенной чувствительности к лекарственным веществам.

Появление со стороны носа патологических изменений (искривление носовой перегородки, полипов, аденоидов) приводит к нарушению носового дыхания и снижает устойчивость слизистой оболочки к инфекции. В результате нарушается проницаемость слизистой, что может способствовать дальнейшей сенсибилизации к пыльце, пыли, грибкам. Поэтому важным профилактическим мероприятием является своевременное устранение причин нарушения носового дыхания, лечение очагов инфекции.

CONTRACEPTION AFTER CHILDBIRTH – CONCLUSION

After childbirth a contraceptive choice must be made as few women will want to risk another pregnancy immediately. As always, that choice will rest on the balance between what is medically appropriate and the emotional factors involved.

The experience of childbirth exerts profound changes, both physically and mentally. The doctor providing contraceptive care is in a unique position to observe these changes, which in most cases will be part of a healthy maturational process but which may have an important effect on the choice of contraceptive method and its efficient use.

*187/197/1*

THE STEREOTYPES – ‘MEN NEED TO BE IN CONTROL’ (WITHDRAWAL)

Can withdrawal be considered the ultimate test of control for the man? It involves fully potent sex up to a point that only he can recognize. Most men have tried it at some time, and talked excitedly about the experience until it came to describing the difficult bit. In addition to recognizing the importance of his own control, several said it was impossible if, at the last moment, the woman grabbed hold with her arms or legs and held him in. These men were describing risky sex, and the group must contain a number whose enjoyment is particularly connected with the risk of conception.

*150/197/1*

INFERTILITY AND THE CONTRACEPTIVE CONSULTATION – INSTANCE

Mrs H. had hidden the nonconsummation of their marriage for eight years. She had requested repeat prescriptions for the Pill, avoided examinations by having a period or a pressing engagement, and had also moved house and general practitioner (GP) on several occasions. Eventually she plucked up courage to approach her new female doctor, saying that she wanted to have a baby and thought it sensible to have a smear before stopping the Pill. She did not mention the lack of intercourse.

The doctor noticed the hesitancy in her preparation to get on to the couch and remove her underwear for the examination. She looked like a young girl, despite her 28 years, rather like a china doll with neatly parted and waved hair, no make-up and wearing a summer dress with puffed sleeves. She sat up on the couch with her arms clutching her knees and to the doctor’s comment about her apparent reluctance to be examined she began to talk about the lack of penetration in their sex life. Nobody had asked her about sex before and if they had the answer would have been ‘it is all right’, for they did enjoy a degree of intimacy when she achieved an orgasm with manual stimulation. It was only now that they wanted a baby that the situation had become a problem.

*113/197/1*

THE DOCTOR AND THE UNPLANNED PREGNANCY

Greater social and medical sophistication in our society has also meant greater involvement between the medical profession and pregnant women. Doctors have become increasingly responsible for the health of the pregnant woman and her unborn child. Laws designed to liberalize abortion have also made doctors more involved with unwanted pregnancies. Throughout the ages and in all societies women have sought to control their own fertility using methods ranging from trying to abort themselves and obtaining an illegal abortion, to infanticide. Although the consequences were sometimes disastrous, it did mean either that women took measures themselves or sought the help of other women. Doctors now have the legal power to terminate a pregnancy and the knowledge to do so safely. If there had been another method of procuring abortion, not requiring medical skill, it is doubtful that doctors would have been so involved. The abortion pill has proved to be a disappointment to women in this way as it still involves medical input. Many women feel that the decision as to what happens to their own body and their own pregnancy should be theirs alone and resent the need to ask doctors for permission to terminate their pregnancies.

*77/197/1*

WHAT ABOUT THE MESS? – USING CONTRACEPTION (INSTANCE)

Silence. In the background, the practice nurse looked at her watch. ‘My husband and I are no longer together.’ Mrs A. looked quickly at the doctor, and then back at her watch. ‘I’ve got a new bloke . . . don’t know why . . . just felt I ought to have a check-up . . .’ Suddenly, the defences were lower, and Mrs A. was able to talk about the new man in her life. ‘He’s smashing, really nice

. . . [another anxious sideways look] but . . . well . . . he don’t really get on with the sheath, says he never had to use it with his ‘ex’. But, there’s no way I am going back on those Pills!’ ‘Why don’t we get on with the check-up,’ said the doctor. ‘We can talk about it then.’

Behind the screen, although the examination continued as requested, the talk was all of contraception. She had hated the Pill, well, to be fair, her ‘ex’ was an alcoholic, had wanted sex when fairly drunk, incapable of it later. ‘Every time I took that Pill, I felt sick.’ The oral contraceptive pill had equalled anger and humiliation. ‘When I left him, I said, never, never again.’ The doctor commented that the anger at the husband had turned into anger at the Pill, and wondered if it was only the new partner who did not like the sheath. Was sex OK now? Mrs A. blushed. ‘Smashing,’ she said, in an embarrassed way. ‘But it is true, neither of us like the sheath. It seems … a bit cold, really.’ (The pelvic examination was normal, and Mrs A. had been completely relaxed. It was warm and intimate behind the screen.) Had she thought of the cap? ‘It had been discussed, originally, but . . . wasn’t it too messy?’ ‘Well,’ said the doctor, ‘so was sex, come to that.’ Both laughed. A cap was fitted, she took it out, put it in again, ‘It’s perfect,’ she said. ‘I like to be able to do it, and I know he will be pleased. Who would have believed it? Fancy that!’

A cheerful, sexy lady left the room. The doctor looked back at her old notes: ‘Cap discussed. Positively rejected.’

*40/197/1*

DRUGS THAT RELAX THE PROSTATE: ALPHA BLOCKERS

Remember the two kinds of dssue involved in BPH? One is glandular and is made up of epithelial cells, which secrete fluid that becomes part of the semen. The other is smooth muscle tissue—the stromal cells, whose automatic contractions squeeze this fluid out of the prostate and into the urethra. In BPH, these kinds of tissue act together as a one-two punch: As the glandular tissue enlarges and begins to clog the urethra, the smooth muscle tissue tightens like a fist, and clamps it. But something else is happening with these two kinds of tissue: The balance between them is shifting. In the normal prostate, there are two stromal cells for every epithelial cell; in BPH, it’s five to one. Researchers have described BPH, on a cellular level, as a «stromal process.» In other words, it’s a smooth-muscle problem. And one way to make the passage of urine easier is by taking a drug that relaxes this muscle tissue.

This concept is still relatively new in terms of mainstream drug treatment for BPH (although scientists have been studying alpha blockers and their effect on BPH symptoms for more than fifteen years). But medical researchers have studied smooth muscle tissue, in blood vessels and intestinal walls, for decades. They know, for example, that its actions are involuntary responses to signals from the nervous system. That certain neurotransmitters—chemical messengers which target receptors on the wall of the prostate’s smooth muscle cells— are responsible for making this tissue contract. That other chemical messengers, designed to block these transmitted signals, can make this clenched tissue relax. And that the distribution of these alpha-1 adrenoceptors—they seem to be particularly abundant in the bladder base and prostate—makes alpha-blocking drugs ideally suited for relieving the obstructive symptoms of BPH. The drugs can selectively target and relax muscle cells in the prostate and bladder neck, while ignoring the cells involved in voluntary control of urination.

This promising class of drugs got its start as a treatment for some forms of hypertension, which can involve the same kind of smooth muscle contractions (in blood vessels, not the prostate) as those in BPH. In 1981, the Food and Drug Administration approved an alpha blocker called prazosin (Minipress), for treatment of high blood pressure. Prazosin has a relatively short half-life in the body, and must be taken more than once a day. In 1986, terazosin (Hytrin), an alpha blocker with a longer half-life, was approved by the FDA for treatment of hypertension. Recently, an FDA panel recommended that terazosin be approved for treatment of BPH. Other alpha blockers such as doxazosin (Cardura) are available, and still others are being investigated for use as potential BPH drugs.

*286\201\8*

SURGICAL TREATMENTS AND PROCEDURES:PROSTATECTOMY

A century ago, a New York surgeon developed a procedure called «simple,» or «open,» prostatectomy. He reached the prostate through the bladder and used his fingers to remove the overgrown tissue surrounding the urethra, leaving the rest of the prostate intact. (This is not the same thing as a radical prostatectomy, the removal of the entire prostate, which is often used to treat localized prostate cancer.) A refined version of this procedure, which surgeons call suprapubic prostatectomy, is still used today in a small percentage of men with BPH; so is a variation of it called simple retropubic prostatectomy.

But another form of prostatectomy, developed nearly fifty years ago, has eclipsed both operations and is now the main form of surgical treatment for BPH. In this procedure, called transurethral resection of the prostate (TUR; also called a TURP), surgeons reach the prostate by taking a different route— through the urethra. Unlike other forms of prostatectomy, this does not involve a long hospital stay; there’s no incision or scar, and the recovery time is shorter. One major benefit of the TUR—and all forms of prostatectomy—is the opportunity to check the prostate tissue that was removed for cancer after surgery.

The TUR is available to men who otherwise might not be eligible for surgery. About 95 percent of the prostatectomies performed in this country are done transurethrally. And despite the development of new techniques to relieve urinary obstruction, the TUR remains the gold standard for BPH treatment.

However, the TUR is not for everybody. For example, men with large prostates (with obstructive tissue that’s estimated to weigh more than seventy-five grams, or two and a half ounces) probably should have an open prostatectomy. So should some men with large diverticula of the bladder that need to be treated, or men with large bladder stones. (Diverticula are pockets of the bladder lining that poke out like balloons through the bladder wall.) If diverticula or bladder stones need to be removed, this procedure can be «piggybacked» onto (done at the same time as) an open prostatectomy—as surgical «one-stop shopping.»

Nor is the open prostatectomy ideal for every man. The average age of men who have a prostatectomy is 70; by this time in life, many men have other health problems that preclude open surgery—such as a history of heart or lung disease, diabetes, or high blood pressure. For most of these men, and for men with a small prostate, the TUR is the best option. The open prostatectomy is generally reserved for younger men, and those with very large prostates who are otherwise healthy and in good cardiovascular condition.

If your health is considered too precarious even for the TUR, there’s still help—a catheter can provide immediate relief of an overfull bladder, for example. Early studies show intraurethral stents to be a good option for long-term relief of symptoms. Also, you may be able to take medication to shrink the prostate.

*247\201\8*

HELP FOR IMPOTENCE AFTER PROSTATE TREATMENT

Men who are impotent after prostatectomy or radiation therapy have normal sensation and normal sex drive, and they can achieve a normal orgasm. Their only trouble may be in achieving or maintaining an erection. And this is a problem that can be fixed.

The purpose of this chapter is not to itemize every possible cause for impotence—there are many—or to discuss every treatment in detail, but to let you know two things: First, that you’re not alone, and second, that help is available.

Here are some statistics: By age 65, about 25 percent of all men are impotent. In the United States, an estimated 10 million men are impotent.

Aging is one reason for impotence. But impotence can also result from medical conditions such as diabetes, hypertension, or multiple sclerosis; from certain medications; from overuse of alcohol, cigarettes or other drugs; even from emotional or psychological problems. For most men, impotence does not have to be a permanent situation. In other words: If there’s a will, there’s generally a way.

*208\201\8*

A WORD ON CASTRATION AND IMPOTENCE: WHAT’S REALLY IMPORTANT HERE?

Castration—chemical or otherwise—is an awful thought, one that makes most men shudder. Loss of sexual function or sense of identity is not a pleasant concept; it can be even worse when combined with the fear and uncertainty that are part of having cancer. This is a scary time, but you are not alone. It might help to talk to your doctor, or family, or men who are going through this, too—see the «Where to Get Help» section at the back of this book.

For many men with prostate cancer, when it comes down to choosing between sexual potency and death, the sex life takes a back seat to survival. When hormonal therapy can truly mean the difference between life and death and you’re preoccupied with sexual potency, you’re missing the bigger point.

It’s time for plain speaking again: Get over it. Now is the time to cherish life: Treasure every extra, precious moment you get to spend with your loved ones. Make the most of every day. Now is the time, while you still can, to do the things you’ve always wanted to do—take that trip you’ve always dreamed of, for instance. Take your wife out dancing. Learn to sail. Teach your grandchild how to fish. Realize there is so much more to living than sexual potency.

*171\201\8*

EXTERNAL-BEAM RADIATION TREATMENT FOR PROSTATE CANCER: SEXUAL FUNCTION

Sexual potency after external-beam therapy is reported to remain in between 54 percent and 86 percent of men. There is a range here because sexual potency is difficult to measure: Age, stage of disease, and a man’s sex life before treatment all play a role in his ability to have an erection afterward. Men younger than 60, who are sexually active and who are treated when the cancer is in the earlier stages (confined to the prostate) are most likely to remain potent after radiation treatment. However, many men treated with radiation are older, and more likely to have problems with impotence anyway—either because they’re taking medications that can interfere with sexual function, or simply because of their age.

One fact you should know about radiation therapy is that its effect on potency is slower and much more insidious than radical prostatectomy’s more immediate impact. Radiation seems to cause a man’s ability to have an erection to diminish over time (months to years); about half the men who receive it are impotent at seven years after radiation treatment. This is probably because radiation acts on the blood vessels, causing an eventual decrease in blood flow to the penis.

*133\201\8*

HOMOSEXUAL OFFENDERS VS. CHILDREN: ANIMAL CONTACTS

Nearly one quarter of the homosexual offenders vs. children sometime in their postpubertal lives had sexual contact with an animal. This is the second largest proportion recorded. While for other tripartite groups of sex offenders these proportions vary widely, it is worth noting that the homosexual offenders are not thus scattered but form a quite cohesive unit occupying second, third, and fourth places in the rank-order.

In age-specific incidence the homosexual offenders vs. children begin at a moderate level: 10 per cent had animal contact between puberty and age fifteen. Thereafter they rise to third rank in age-period 16-20 (9 per cent), tie for the first rank in age-period 21-25 (7 per cent), and occupy undisputed first rank in age-period 26-30 with 5 per cent. These offenders, one will recall, ranked first among those with dreams of animal contact and fourth in masturbatory fantasy of this activity; the figures are small in absolute terms, but indicate an above-average interest in sexual activity with animals. Since the group is not particularly rural in background and the other homosexual offenders are even less so—in fact, they are among our most urban groups—one must obviously look elsewhere for an explanation for the unusual incidence of animal contact.

We are of the opinion that self-masturbation and sexual contact with animals are basically very similar; one may legitimately think of animal contact not as something unique and separate, but as a form of self-masturbation—the human using the animal merely as a masturbatory device. Since the homosexual offenders are characterized by their great emphasis on masturbation, it may well be that their relatively high incidence of animal contact experience is simply the result. This hypothesis is strengthened by the fact that the heterosexual aggressors vs. minors, who have the highest incidence (33 per cent) of animal contact, also display an uncommon amount of self-masturbation.

While, as is usual, most of the animal contact occurs between ten and twenty, the homosexual offenders and particularly the homosexual offenders vs. children tend to continue it later in life. This tendency cannot be shrugged off by saying that since our homosexual-offender sample is larger than our other sex-offender samples one could expect to find more cases of rare activity, for our two other large sample groups, the prison and the control, do not contain anyone who had animal contact beyond age thirty-five. Indeed, in the prison group there was no animal contact beyond age twenty-five.

*177\161\2*

INCEST OFFENDERS VS. CHILDREN: SUMMARY

The early life of the typical incest offender vs. children was stigmatized by a poor adjustment between him and his parents, an even worse adjustment between his father and mother, and—not surprisingly—a rather large number of divorces and separations. To this was added financial trouble, so that taken as a whole his home must have been rather a wretched place.

One could make a good argument that in his boyhood the incest offender vs. children turned from his unhappy home situation and relied on sex for his emotional needs. There was much prepubertal sex play, chiefly with girls. After puberty his reliance on sex became stronger and more easily recognized.

The typical offender, as an adult, appears to be a rather ineffectual, nonaggressive, dependent sort of man who drinks heavily, works sporadically, and is preoccupied with sexual matters. This last trait is seen in his great emphasis on mouth-genital contact, variations of coital position, and lengthy foreplay—all statistically abnormal in his socioeconomic stratum. To this list can be added a high incidence of extramarital coitus, a high incidence of masturbation while married, and strong sexual response to thinking of or seeing females.

A man who is thus preoccupied with sex, who is often at home with the children during periods of unemployment (also the wife is frequently away working), and who drinks heavily, is a man ripe for an incest offense.

*135\161\2*

HETEROSEXUAL AGGRESSORS VS. MINORS: PREMARITAL COITUS

Ninety-six per cent of the aggressors vs. minors had premarital coitus. They exceed most groups in the accumulative incidence of those with this experience: 46 per cent (second rank) by age fourteen, 74 per cent (second rank) by age sixteen, and 88 per cent (second rank) by age eighteen. At older ages they lose their position of leadership.

In age-specific incidence they are again quite high, ranking third from puberty to fifteen, with half of their number having had premarital coitus with companions in that span of time. In the next age-period they rank first with 91 per cent, and in the next age-period (21-25) they rank second with 87 per cent. In terms of age-specific incidence of premarital coitus with prostitutes, they have moderate percentages.

Of all our comparative groups, fewest of the aggressors vs. minors (8 per cent) had their first coitus with a prostitute. This unexpected fact is probably in part the result of the large number who began coitus at an early age. In general, prostitutes are disinclined to welcome very young clients. It is probable that the relative social and sexual success enjoyed by the aggressors vs. minors in their teens would tend to minimize their commercial coitus.

There is nothing outstanding about the frequency of their premarital coitus with companions. On the basis of the rather small sample, it appears that the average (median) individual had relatively low frequencies between puberty and age fifteen (10 per year) and moderate frequencies (18 per year) between sixteen and twenty. The mean frequency shows an intermediate rank-order position between puberty and twenty (1.3 per week). The proportion of total outlet derived from premarital coitus with companions is always moderate. In the one age-period (16-20) where sample size permits calculation of frequency of premarital coitus with prostitutes, the aggressors vs. minors display the lowest frequency, mean or median. Naturally the proportion of total outlet derived from such coitus is also small.

Before marriage the average aggressors vs. minors had coitus with about ten companions—a moderate number but well above the number reported by the control group. The number of prostitutes, whether in the total life span or in premarital life, is low (six). The median control-group individual had gone to ten prostitutes prior to marriage.

In summary, the aggressors vs. minors appear as a moderately successful group as far as obtaining coitus with companions is concerned, and while they were willing to resort to prostitutes when companions were unavailable (hence their somewhat high figures in accumulative incidence) they seldom needed to do so (hence the low number of prostitute partners).

Like the aggressors vs. children, the aggressors vs. minors were relatively free from the restraints that prevented many others from having a greater amount of premarital coitus. In fact, the aggressors vs. minors are the least restrained of any group. Only 4 per cent reported that moral considerations had seriously interfered with their coitus; 7 percent (again a very low percentage) said that fear of impregnating their partner was a real deterrent; and 4 per cent (still the smallest percentage ) were inhibited by fear of disease. Again 4 per cent (this time the second smallest proportion) reported that fear of adverse public opinion was a strong restraint. Lack of opportunity was by far the most important deterrent, four fifths reporting that this was a definite reason for their not having more premarital coitus; this is the largest percentage reported by any group. The fact that their incidence figures are large while their frequencies are rather low seems to substantiate their complaint. A moderate number, 24 per cent, told us that lack of interest was a major reason for not having more frequent coitus. Some of this 24 per cent represents satiety, although the aggressors vs. minors are not notable for their number of coital partners; an additional portion may be genuine disinterest, since the aggressors vs. minors display (as we shall see) a fairly strong homosexual component.

In connection with the absence of restraints and the relative sexual amorality, it is interesting that no aggressor vs. minors expressed a strong desire that his bride be virginal. On the other hand, few wanted an experienced bride; the majority (69 per cent) were completely indifferent.

*93\161\2*

HETEROSEXUAL OFFENDERS VS. MINORS: MARRIAGE

Nearly 62 per cent of the offenders vs. minors had married before they contributed their case histories, the average individual having married at age twenty-one. The accumulative incidence figures show that by forty-five some 84 per cent of the offenders vs. minors had married. These married men had spent 41 per cent of their lives after puberty as husbands—a moderate proportion and one very similar to that of the other heterosexual offenders. They were, however, much more monogamous than the offenders vs. children: nearly two thirds had married only once, a moderate proportion. They were not distinctive in the number of brief marriages that ended in separation or divorce.

On the other hand, they had known their future wives for a relatively long time prior to marriage, and about half a year longer than the average offender vs. children. Actually, the offenders vs. minors share with the homosexual offenders vs. children the honor of the longest prenuptial acquaintance of all sex offenders; only the control group surpasses these two.

About half had had premarital coitus with the women they eventually married and only a moderate percentage of the women marched pregnant to the altar. This same reproductive moderation is again seen after marriage: there were 16 children born for every ten offenders vs. minors. Since the average married offender vs. minors was thirty-three years old at the time of interview, additional children can be expected.

There is nothing distinctive about this group of men so far as the time spent in precoital petting in marriage is concerned, but in the techniques they used they do appear apart from others. The married as well as the single men were averse to mouth-genital contact. Eighty-five per cent, the largest proportion of any group, had never had mouth-genital contact in marriage. As we have previously pointed out, this evident aversion to mouth-genital contact may well be partly a result of our sampling—the great majority of our offenders vs. minors and adults came from one institution and are more rural and less educated than most other sex offenders; these characteristics are usually associated with lesser incidence of mouth-genital contact.

A similar conservatism in coital technique is seen in a study of coital positions: 25 per cent of the offenders vs. minors, a rather large proportion, had never employed any but the usual female-supine male-prone position in marriage. An even stronger indication of conservatism is the fact that only 3 per cent had ever had anal coitus with their wives— this is the second smallest percentage recorded, even less than that of the control group.

While the offenders vs. minors displayed rather extensive premarital sexual lives, their frequencies of marital coitus are, by and large, moderate. The average (median) offender vs. minors began with a marital coital frequency of 2.8 per week in age-period 16-20, a frequency that declined to 1.75 by age-period 36-40. These figures are less than those of the control group. The proportion of total sexual outlet derived from marital coitus is also moderate, ranging from 80 to 90 per cent.

Insofar as the wife’s sexual satisfaction was concerned, the offenders vs. minors claimed a rather good record, according to their possibly optimistic report. Some 62 per cent of the years of marriage found the wives experiencing orgasm 90 per cent or more of the time—only three of our usual 16 comparative groups exceed this figure.

When asked to rate their marriages in terms of happiness, the offenders vs. minors gave a good but not glowing report. They stated that 46 per cent (fourth largest) of their years of marriage were very happy; 26 per cent (relatively few) were moderately happy; 18 per cent (a moderate proportion compared to other groups) of the years were rather unhappy; and few (10 per cent) were very unhappy years.

*51\161\2*

METHODS AND TERMS: INCIDENCE

In this study we have employed three kinds of incidence:

1. Ever-never. This is the simplest form of incidence, telling whether a person ever or never had a particular experience. For example, 76 per cent of the control group had premarital coitus.

2. Accumulative. This form of incidence tells one what percentage of individuals ever had a particular experience by a given age. For example, 72 per cent of the control group had premarital coitus by age twenty.

3. Age-specific. This form of incidence tells what percentage of individuals experienced a particular activity within a given period of time. We have chosen five years as the period of time and have labeled these years in terms of the person’s age. Thus, after the initial age-period of puberty-15, we have five-year age-periods such as 16-20, 21-25, 26-30, etc. There are, however, a number of important exceptions to this generalization. For instance, we use puberty as a beginning point of adult life, and since puberty is attained at varying ages our first age-period, puberty-15, may contain fewer or more than five years. In the rare cases where puberty is reached after fifteen, our usual second age-period, 16-20, may contain fewer than five years. A termination point in an age-period occurs at the time the person was interviewed: a man interviewed at age thirty-eight obviously has not lived all five years of age-period 36-40. Thus a man’s last (or current) age-period is usually less than five years in duration.

    In addition to these time distortions at the beginning and end of a life span, there may be others if the person has been in an institution. We have in this study ruled out the years of life spent in prisons and mental institutions; hence, part or all of an age-period may be deleted. For example, a man who between thirty-one and thirty-five spent three years in a prison has only two years of noninstitutional life in that age-period, but we treat these two years as if they were five. In brief, we assume that had he not been imprisoned the three years would have not been importantly different from the two years he actually lived outside of prison. This assumption is easily defended in cases where the man was «out» at ages thirty-six and thirty-seven and imprisoned from thirty-eight to forty. However, the assumption is in greater danger of error when the man was imprisoned from thirty-six to thirty-eight and «out» from thirty-nine to forty—here the assumption overlooks the possible effects of prison on postprison adjustment. Since we encounter all possible combinations of prison and nonprison life within and overlapping our five-year age-periods, it has been deemed impractical to attempt at this time anything beyond what we have done.

In order to be counted in an age-period a person must have lived six months or more in that period. For example, a man aged thirty-six years and five months is retained in age-period 31-35. whereas a man who has lived thirty-six years and six months graduates into age-period 36-40.

In both accumulative and age-specific incidence, as well as in many of our presentations of frequency, we use five-year age-periods that end on a quinquennial year as follows: puberty-15, 16-20, 21-25, 26-30, etc. These class intervals do not agree with those used by the census and many others, who prefer to begin their periods with a quinquennial year, for example: 15-19, 20-24. Neither method has any great advantage over the other; we have retained our method only because our raw data are often expressed in this form.

Incidence, as we currently define it, concerns the presence or absence of a particular activity regardless of whether that activity resulted in orgasm.

*8\161\2*

MALE MENOPAUSE: THE SURVIVAL COURSE: THE PHYSICAL FOUNDATION – DIET: OR EATING SENSIBLY (DIETS)

Avoid all fried foods as they soak up quantities of fat. If your family insist on a once-a-week fry-up either do not eat it or insist the food is fried only in a small amount of vegetable oil — never dripping or meat fats.

Unless your taste buds rebel switch to margarine, or low-cholesterol spreads instead of butter which is high in cholesterol. If you must eat butter do so only in moderation.

Say No to cream.

Cut down on cheese as it is rich in animal fat. Go easy on milk. Eat no more than three eggs a week.

Use only a little salt especially if already you have high blood pressure problems. Beware of the high salt content in most convenience foods, tinned or frozen.

Cut out sugar. This means sweets, cakes, biscuits, chocolate, ice cream (which is also high in fats) and colas and soft drinks. If you crave sweetness eat fruit.

Apart from the items listed in the rules above you can eat anything you like but when it comes to bread, pasta, rice and potatoes eat them only in moderation as they are high in carbohydrates, therefore fattening.

*154/153/1*

MALE MENOPAUSE: HOW TO SURVIVE – SURVIVING THE SEX CRISIS (ENJOYING SEX)

Consider too that it has been established the more sexually imaginative a couple are, the more frequently they will enjoy sex, the more pleasure both will derive and, in fact, during the menopause it is vital to reconsider your ideas on sexual demands and responses, on what you should or should not do, on who does what to whom and when. Consensus of opinion today promotes the theory that applies as much to the jaded as to the temporarily impotent: anything goes as long as no one is hurt. (This definition perhaps should be revised for sado-masochistic circles.)

By forty every man should be aware of the sexual variations and alternatives available to him and his partners. So the true meaning of loosening up may be: experiment. Be less inhibited about oral sex, masturbation and fantasy pleasures. Enjoy what you are doing or having done to you.

*118/153/1*

MALE MENOPAUSE: INTRODUCTION (PRELUDE AND STIMULATION)

Many, heterosexual or homosexual, can never have enough sex whatever their age. They are insatiable and enjoy variety. It flatters the ego, feeds their innate sense of masculinity and makes them feel good. Around forty this lust is hardly diminished. A man may take a little bit longer to come to orgasm than he did at twenty and perhaps his ejaculation is a little less powerful but his desire remains as strong as ever. In fact taking a little longer time during sex may make him a better lover: his orgasm is likely to be more intense and his partner will

probably appreciate the longer lasting erection.

By forty a man will also have developed his own specific tastes as a prelude and as stimulation for sexual pleasure. Some enjoy a romantic candle-lit dinner to set the scene, others prefer to snatch their pleasures illicitly in the heat of a summer’s afternoon after a good lunch. Many indulge in fantasy, playing out roles or dressing up and using toys, bondage and other devices. For others part of the pleasure is paying for it, buying sex and a few can only enjoy frenzied sex treating their partner roughly as they take their pleasure fast, selfishly, like a man possessed. To each his own. As a London therapist says:

‘As long as it is pleasure and no one gets hurt anything goes and is good for you.’

*81/153/1*

MISSING OUT OR FEELING CHEATED: AT HOME – FAMILY FEUDING; SELF -QUESTIONING

Tied in with the belligerence borne of frustration, a man can goad his family or even his friends into a sniping war by his ill-temper. Children against parents, each individual against the other. Wives are alienated, grandparents shaken, best friends upset; marriages break and lovers are lost all because inner frustration is driving the man into irrational, fighting mood. Words sting.

Irreparable damage can be done. Apologies are hard to come by and insufficient.

Now what? Essentially a part of his fears of failure, he sees a need to question every motive and every move. No part of his life feels like a success no matter how family or friends try to prove that it is. He wants to achieve more but he does not know what it is he wants. When he makes a decision he is always plagued with the doubts: is it worth it? and why should I bother?

As he doubts himself he questions his worth. He can be very gloomy to be with.

*46/153/1*

MYTHS – PACKAGING

‘If you see a man with his genitalia laid out exhibitionistically down the front of one of his trouser legs you know he has menopausal problems.’

fact: Perhaps. Few M-M men exhibit themselves this way or think of doing so. This predilection is usually seen as a sign of aging with incidence higher among gay men than heterosexual. Many therapists in the United States believe that when a man of forty-plus starts dressing this way it is simply because he is worried about his declining sexual appeal and so believes by showing his prowess and availability all will be cured.

Perhaps the most important foundation to these myths comes from woman’s knowledge of meo. Looking around her circle and talking among wives it would seem that around their early forties men seek less sex with their regular partners and, if they are still able to perform fully in bed, then they are likely as not to go off the rails entirely chasing younger beauties, especially starlets, secretaries and air stewardesses. Many women see the male-menopause as either giving a man rampant sexual urges or stopping them altogether. On the whole they take more comfort from the latter.

*6/153/1*