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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*

BODY SIGNAL ALERT DENTURES THAT DONT FIT PROPERLY: TREATMENT

The most important thing to do to prevent damage to your gums and your remaining teeth if you wear dentures is to go for regular dental checkups so your dentist can detect any tiny changes that occur in the fit of the dentures and make appropriate adjustments. It’s important to see your dentist immediately upon noticing any change in the way your dentures fit. And, as your bone structure changes over the years, your dentist will occasionally need to make a new denture for you.

The abrasion of the denture against your bone and the resulting irritation may occasionally result in an infection of the soft tissue of the gum. If this occurs, your dentist will prescribe an oral solution of antifungal medication such as nystatin suspension or Mycelex troches, lozenges that you’ll slowly dissolve in your mouth. Both should be taken three to five times a day for a week or two to totally clear up the infection.

Tips and Precautions

Some people sleep with their dentures in, but this can aggravate and speed up the deterioration of gum and bone tissue. Your gums need a break from the pressure the dentures place on them. That’s why it’s important to clean them thoroughly each night and to store them in a glass of water each night to prevent them from warping.

*232\167\8*

EARS, BUZZING AND HISSING SOUNDS IN

Description and Possible Medical Problems

If hitting the buzzer on your alarm clock each morning does nothing to relieve the constant ringing or buzzing in your ears, you probably have tinnitus. And you have probably lost some of your hearing as a result of the aging ear.

Tinnitus is a ringing in the head. It is usually caused when the arteries in the ear—like elsewhere in the body—begin to narrow; as a result, the ear «hears» the blood rushing through the ear. And sometimes a person with tinnitus can hear his own heartbeat. Regardless of the particular sound, however, tinnitus tends to get worse at night, when there is a lack of sounds to drown it out. And some people may feel they need to seek psychological treatment, because the constant sound can begin to drive them crazy.

Treatment

It’s sometimes difficult to pinpoint the sudden onset of tinnitus, since the cause can be due to an infection or obstruction, or to an underlying disease such as anemia or arteriosclerosis. If you have tinnitus, it’s important for you to see a doctor to rule out the possibility of a serious disease.

To diagnose tinnitus, your physician will go through an elimination process. Sometimes the culprit is as simple as removing an accumulation of earwax, which is the first thing she will check for. Next, she will test your hearing with a tuning fork to see if you have a problem hearing it. She will also do a neurological exam to check your coordination and balance, and if she finds that you have lost some degree of control over your balance in addition to having a significant hearing loss, you will be referred to a hearing specialist.

It might be a good idea to eliminate caffeine, alcohol, and cigarettes, since these can frequently aggravate tinnitus. People with constant tinnitus find that playing the radio at night helps drown out the ringing enough so they can fall asleep. Others have found that a sound machine that emulates water can help mask the ringing, as can a fan or air conditioner. Or, if you live in the city, just open the window. Often, a standard hearing aid will help ease the ringing of tinnitus because it decreases the internal buzzing and amplifies external noise.

*215\167\8*

VISION, SLOW, PROGRESSIVE CHANGE IN, ACCOMPANIED BY GENERAL CLOUDINESS: TREATMENT

If you’re one of those people who develop a mild case of cataracts and your vision remains relatively stable, your doctor may suggest that you do nothing for the time being. She may prescribe special eyedrops, which will enlarge the pupil and thus reduce the effect the cataract has on your vision, and take a wait-and-see approach. But if the cataracts develop and begin to hamper your eyesight, the only treatment is surgical removal.

Because cataract removal is such a common and relatively simple procedure, the surgery can be done under local or general anesthesia on an outpatient basis. During the operation, the lens of the affected eye is removed and a new, artificial lens is inserted in its place. The surgery takes about an hour, and the new lens may negate the need for glasses or contact lenses, since the surgeon can tailor a lens so that it will be the only corrective lens you’ll need.

My mother had her cataracts removed several years ago, and after the surgery she had to wear an eye patch for about a week. The family arranged for my sister to stay with her during that time, because we were concerned that she might fall because of her temporary loss of vision. Three weeks later, she was back to driving her car without wearing glasses.

For some people, however, a lens implant is unwise because of the shape and structure of the eye. In this case, when the lens is removed and no artificial lens is inserted, you will become farsighted. However, this condition can be corrected with eyeglasses or contact lenses.

Cataract removal with or without lens implantation will improve most people’s vision. Sometimes, however, the eyesight will remain poor. In this case the problem may lie with the retina, and your doctor will be able to treat this condition as well.

*198\167\8*

FOCUSING, PROBLEMS IN

Description and Possible Medical Problems

If you have had trouble focusing your eyes lately, you should check to see if other symptoms are present. You should also ask yourself whether the focusing problem has come on suddenly or has appeared gradually. If your inability to focus appears all of a sudden, the problem is frequently just one of several symptoms—such as redness and irritation—that signal a temporary eye disorder such as conjunctivitis, the inflammation of another part of the eye, or a corneal ulcer.

Treatment

If you’ve only recently noticed that you find it difficult to focus easily, the problem is usually easy to fix. Maybe all you need is to have the strength of your glasses or contacts increased. Deterioration of vision is a given for most midlife adults, but the good news is that after the age of 65, usually no further vision loss takes place. In fact, some people have discovered that the shape of their eyes has changed in such a way that they don’t have to wear glasses at all. If, however, your inability to focus has appeared suddenly and your eyes are red and painful, you probably have an eye infection, and you should see your eye doctor to clear it up. For treatment details, see «Discharge with Redness» above.

Rest assured that if you’re having trouble focusing and it’s not accompanied by any other eye problem, it’s a normal sign of aging and is usually nothing to worry about.

*183\167\8*

BODY SIGNAL ALERT EYE PAIN WITH REDNESS: DESCRIPTION AND POSSIBLE MEDICAL PROBLEMS

When you feel a pain in one or both eyes, it is usually one of several symptoms that accompany other eye problems. However, when it appears by itself and is accompanied by redness, it is usually due to an inflammation of one of the parts that make up the eyeball. Just as conjunctivitis, or pinkeye, is an inflammation of the conjunctiva (the membrane that lines the insides of the eyelids and part of the eyeball), other parts of the eye can also become inflamed. These include the iris, which is the colored part of your eye, and the sclera, a transparent film that serves as the outermost layer of the eye.

The choroid is located in the back of the eye, between the retina and the sclera. The choroid is the layer of the eye that contains the many blood vessels that nourish the eye, and, like the other parts of the eye, the choroid can become inflamed.

Iritis, or inflammation of the iris, is sometimes known as uveitis since the iris is part of the uvea, a membrane that lies just underneatl the sclera. The retina at the back of the eye can also become irritated.

Some of these conditions—such as scleritis—are more likely t( appear in a person who has rheumatoid arthritis, while others may arise for no apparent reason. Because it will be difficult for you to detemint – the cause of the pain yourself and the only symptom you’ll have is gen eralized pain in your eye with perhaps some redness, it’s important that you see your doctor.

*168\167\8*

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*

HOW TO PROTECT YOUR EYES FROM AGING SIGN

The aging process can be especially noticeable in the area around your eyes. That’s because the skin around your eyes is thinner and more delicate than on any other part of your body. To slow the aging process in the area around your eyes you must do everything you can to protect the entire area— including your eyelids.

There are several routine factors that cause wear and tear around your eyes. By avoiding or minimizing these factors you can maintain your smooth, youthful skin, and, in effect, a youthful appearance around your eyes.

1) Friction— done often enough, even a minimal amount of rubbing can cause injury to the skin around the eyes. That’s why it is important that you avoid, as much as possible, the common habit of rubbing your eyes, especially when they feel tired or sleepy. Rubbing your eyes in such a manner causes friction and could produce or worsen bags under the eyes because the skin stretches. Often, people who rub their eyes frequently, end up looking weary even when they are not.

2) Applying and removing makeup— the application and removal of certain kinds of eye makeup can also cause stretching, and lead to the appearance of «tired eyes». Whenever eye shadow or eye liner is applied and whenever makeup remover is used to remove waterproof mascara and liner, the skin is bound to be stretched. Some cosmetic consultants recommend that you use only an eye-brow pencil and non-waterproof mascara on the area around the eye, except on special occasions. Neither product involves the application or removal of cosmetics to and from the skin, and both come off easily at the end of the day with just a little soap and warm water.

3) Squinting— even a natural adaptive response such as squinting can eventually help make you look older. Most people squint instinctively as protection against excessive light. You are also likely to squint when you are trying to focus on something you are not able to see very well. While it may seem rather innocuous, such squinting simply «engraves» squint lines, or crow’s feet, around your eyes.

The best way to prevent squinting and the resulting damage to the skin around your eyes, is to wear tinted glasses to protect your eyes against bright light while you are outdoors, and glasses or contacts indoors or out to correct any vision problems.

Since wind and extremes of temperature compound the damage caused by chronic sun exposure, wearing glasses can also provide a shield against the elements. Even if you wear contact lenses for general use, it’s a good idea to have a pair of tinted or plain glasses on hand to wear whenever you go outside to help prevent the signs of aging around your eyes.

*231\27\8*

HOW TO PREVENT AND GET RID OF ATHLETE’S FOOT

You don’t have to be an athlete to contact this common skin condition in which the skin between the toes becomes itchy and sore. Sometimes the skin will crack and peal away and, on occasion blister. The culprit is a fungal infection which thrives in warm, moist conditions. Sweaty footwear is often the breeding ground for this painful and annoying foot menace.

Here are some suggestions on how to prevent athlete’s foot and how to treat it once you’ve got it:

1) Buy two pairs of shoes— if possible, never wear the same pair of shoes day after day. It normally takes shoes at least 24 hours to dry out completely. You can also try keeping the insides of your shoes dry and clean with frequent use ol antifungal powder or spray and by wiping them with a disinfectant, such as Lysol, occasionally. Shoes that allow evaporation of moisture are best.

2) Change your socks— if your feet have a perverse tendency to perspire a lot, it’s a good idea to change your socks two or three times a day— cotton socks are best. To prevent the organism from breeding, it’s important that you make its living conditions as inhospitable as possible—clean and dry.

3) Dry your feet— after a shower or a bath, make sure your feet are allowed to dry thoroughly before you put them into shoes and socks. Once you’re sure your feet are dry, apply powder to help them stay that way.

4) Don’t go barefoot in public— you can help reduce the risk of contracting athlete’s foot by wearing slippers and/or shower shoes whenever you are in places where other people often walk around barefoot— swimming pools, health clubs, spas, gyms, locker rooms, and so on.

5) Wash your feet— once you have it, careful hygiene is often treatment enough, without having to resort to drugs. At least twice a day, you should wash the space between your toes with soap, water and a cloth. Be sure to dry the infected area thoroughly with a towel— especially the painful area between the toes. And always put on clean, dry socks.

6) Try aluminum chloride— a twice-daily application of a 30 percent aluminum chloride solution is often effective treatment because of its drying and antibacterial properties. Have your pharmacist make up the solution and use a cotton swab to apply it between your toes at least two times a day. Continue the treatment for two weeks after the condition has cleared up.

7) Use over-the-counter medications— once the infection has cleared up, you should take every precaution to keep it from recurring. One way to do that is to apply over-the-counter antifungal cream or lotion.

*268\27\8*

EXERCISE AND CHOLESTEROL

Exercise combined with other healthful lifestyle choices, such as weight control and being a non-smoker, can help raise high-density lipoproteins (HDLs)— also known as «good cholesterol»—and as a result reduce certain health risks, including heart attack.

Medical experts say that even though HDL levels are to some extent genetically determined, they can be raised several ways, without using medication. In studies at Stanford University and Medical College of Virginia, losing excess weight and kicking a smoking habit have both been shown to lead to an increase in HDL levels. Postmenopausal women receiving estrogen replacement therapy also tend to have higher HDL levels.

Regular exercise is another method of ensuring high HDL levels. Experts say that regular muscle contractions stimulate the production of HDL. And while vigorous exercise produces the greatest effect, studies indicate that even mild exercise is of some benefit in raising HDL levels.

*305\27\8*

HOW TO GET RID OF URINARY TRACT INFECTIONS

These infections are caused by one or more types of bacteria invading the bladder, urethra, or other parts of the urinary tract. Common UTI symptoms include a burning sensation on urinating and frequent urination. Backache and fever may also accompany the infection. Doctors say that at least 50 percent of all women will contract a bladder infection, sooner or later. Here are several expert recommendations for reducing the discomfort of UTI.

1) Drink a lot of water or juices— urologists say you should drink plenty of fluids— water and juices—to flush out the bacteria that are causing the inflammation. While there’s no conclusive evidence, some recent studies suggest that cranberry juice may indeed be an effective treatment for UTI.

2) Avoid coffee, tea and alcohol—these fluids may irritate the urinary tract.

3) Soaking in a hot bath— many women find this a good way to get relief from UTI.

4) Try an anti-inflammation drug— both aspirin and ibuprofen may help to reduce the inflammation in the bladder.

5) Get more vitamin C in your system— some doctors say that large doses of vitamin C can acidify the urine enough to disrupt the growth of bacteria. Before you begin taking vitamin C as a treatment for UTI, you should get your doctor’s approval.

6) Urinate before intercourse— an empty bladder can reduce the likelihood of irritation in the pelvis by allowing more space. It also helps get rid of bacteria that may be present in the vagina.

*343\27\8*

ADVANTAGES OF BREASTFEEDING: WHAT YOUR DOCTOR MAY NOT HAVE TOLD YOU

One of the most important decisions a. mother makes in the months preceding her baby’s birth is how she will feed her baby. According to medical childcare experts, more and more mothers these days are choosing to breast feed. The decision seems to be a wise one because the American Academy of Pediatrics has labeled breastmilk as the «perfect» food for a baby during the first year of life. Moreover, breast milk is easy for the baby to digest, and it provides antibodies until the baby’s body can make them on its own. Breastfeeding also provides a special closeness for mother and baby, and it helps restore the uterus to pre-pregnancy size.

Here are several things a mother can do to ensure successful breastfeeding:

1) Go to breastfeeding classes before the baby is born.

2) Try to nurse the baby as soon as possible in the delivery room. Research shows that babies who begin nursing almost immediately after delivery are more successful at breastfeeding.

3) Nurse your baby as often as 8 to 12 times a day for the first few weeks, and let the baby nurse as long as he or she wants. The more a baby nurses, the more milk a mother will provide.

4) Allow the baby to nurse from both breasts during each feeding. Nurse on one side until it appears the baby is losing interest, then offer your baby the other breast.

The next time you feed your baby, begin with the side you ended with the time before.

5) Don’t give your baby supplemental bottles or a pacifier until you have been nursing successfully for more than three weeks and the baby is gaining weight.

6) The key to success for any breastfeeding mother is to pay attention to her baby, and having the support of those around her in her decision to breastfeed. Some experts even recommend joining breastfeeding support groups.

Any prospective mother considering breastfeeding her baby should consult a pediatrician who is supportive of breastfeeding and can help with any questions or problems that might arise.

*380\27\8*

IS PROZAC AN EFFECTIVE TREATMENT FOR PANIC ATTACKS AND AGORAPHOBIA?

Yes, it is. Prozac has a powerful effect on the frightening bursts of anxiety and rising waves of panic that characterize panic disorder, the symptoms of which include shortness of breath, dizziness, rapid heartbeat, sweaty palms, trembling, choking, chest pain, and fear of going crazy, passing out, or dying. In one study, nineteen out of twenty-five patients who were treated with Prozac for panic disorder and, in some cases, agoraphobia, showed moderate to remarkable improvement in their symptoms. Treatment was most effective when it started at the low level of 5 mg a day.

It is likely that Prozac and other medications, by alleviating panic attacks, can also cause a decrease in the symptoms of agoraphobia, the debilitating fear of open spaces, including going into crowded streets and department stores that often results in patients becoming completely housebound, sometimes for years on end.

Behavioral therapy, typically including exercises aimed at desensitizing the patient to frightening stimuli, also plays an important role in the treatment of both panic disorder and agoraphobia. Patients with panic disorder, agoraphobia, or social phobia, should use a combination of an antidepressant and behavioral therapy.

*106\22\4*

WHAT DO PATIENTS AND PSYCHIATRISTS MEAN BY A NORMAL MOOD?

The expression «normal mood» is basically an artificial construct. In reality, most people experience mild and transient moodswings. Anyone can feel more down than usual or more up than usual for a few hours or several days; those mild mood fluctuations are part of what we mean by normal. But when the person is always revved up or always down in the dumps, when these up or down feelings become so strong that they go beyond the usual baseline range, psychiatrists begin to consider the mood pathological even if the patient does not

Patients are likely to define the word normal in individual ways that entirely depend on their personal fusion. For people with a life-rime history of minimal depression, normal is for them slightly depressed. To psychiatrists seeing these patients and comparing them with hundreds of other people in the general population, these patients are clearly more depressed than the cultural norm and would be diagnosed as such. These people might be considered hypothymic; their mood is at the bottom of normal or slightly below.

Similarly, hyperthymics who have been energetic, driving, and productive all their lives usually see this as their normal mood. However, experts in mood disorders know that these people are more energetic and active than are most people in the population. These people lead lives at the top of normal or slightly beyond—although they describe themselves as «normal.»

*86\22\4*

HOW COMMON ARE SUICIDAL THOUGHTS OR FEELINGS AMONG PEOPLE WHO ARE DEPRESSED?

Because 15% of patients with bipolar manic depression ultimately commit suicide and the rates for unipolar depression seem to be similar, it would appear that suicidal thoughts are very common.

Between 40% and 60% of patients undergoing an acute episode of major depressive disorder have suicidal thoughts, and an even higher percentage may have a history of suicidal thoughts or wishes. Many other psychiatrists and psychophannacologists would go even further, believing mat as many as 90% of patients who appear in the psychiatrist’s office for the treatment of acute or chronic depression have at some time at least expressed the thought that «I sometimes wish I were dead,» or «My family would be better off without me,» or «I wish I could go to bed and never wake up,» or «I just wish I’d get hit by a car.»

In 1991, a total of 30,810 people killed themselves, making suicide the eighth leading cause of death in the United States. Provisional data indicate that fewer people killed themselves in 1992, dropping suicide a notch on the ladder of death. As of this writing, suicide appears to be the ninth leading cause of death, right behind a new entry in the top eight HIV infection.

But regardless of the precise figures, the likelihood is strong that far more people than reported actually died by their own hands. Because there is still a stigma against suicide, not all self-inflicted deaths are so labeled, and many forms of suicide, such as single-car accidents and death through drug abuse, are neither acknowledged nor identified as such.

Moreover, the number of people who attempt suicide without success is thought to be fully eight to ten times larger than the number of those who succeed.

*66\22\4*

DOES PROZAC AFFECT THYROID FUNCTION?

Depressed patients are first required to have a complete physical exam, an EKG, and a blood chemistry profile that measures, among other substances, the level of thyroid hormone. Because an amount below the normal range is sufficient in itself in some cases to cause depression, patients with underactive thyroids may need first and foremost to take thyroid medication. If the depression has not begun to disappear on thyroid hormone alone after seven to ten days, a trial of an antidepressant is initiated. However, if patients are already in a major depression superimposed on hypothyroidism, they may need an antidepressant as well as the thyroid hormone.

Fortunately, studies have shown no important interactions between Prozac and thyroid hormone. The two medications can be taken simultaneously. Thyroid hormone is usually given as levothyroxin. Cytomel or T3 (triiodothyronine) is given to boost the action of tricyclic antidepressants and used as a step-up treatment with Prozac if the antidepressant is not doing the job on its own.

To date, no clear-cut warning has been given regarding any important adverse effects of Prozac on the thyroid. Very infrequent cases of hypothyroidism have been reported with patients on Prozac. Even more rarely, goiter and hyperthyroidism have been reported, although they probably are not related to the Prozac treatment.

*44\22\4*

PROZAC: WHAT TIME TO TAKE IT AND OVERDOSE.

Prozac is usually taken in the morning after breakfast, which seems to produce fewer side effects, particularly nausea and insomnia. But some patients have been able to tolerate it with other meals or at other times of the day, including bedtime, without adverse side effects. Many patients take Prozac at a time when it is most convenient for them or simply easy to remember, whether in the morning, after dinner, or at bedtime.

Can you overdose on Prozac? Not easily. During preclinical trials with Prozac up to 1993, no deaths occurred in patients receiving Prozac in normal doses. Two deaths were reported during comparative clinical trials, but in both cases other drugs were involved, so the role of Prozac is not clear. Another thirty-two patients recovered after overdose without any lasting harm, including one who reportedly took 3000 mg of Prozac, which is over thirty-seven times the recommended maximum dose of 80 mg.

In contrast, it is easy to overdose with other antidepressants such as the TCAs and MAOIs due to the toxic effects of high doses on the heart. With Prozac, even in large amounts, the risk of serious cardiovascular or neurologic harm is very small. Prozac should be considered one of the safest of all the antidepressant drugs.

If I will take a capsule by mistake, will it hurt me? No. A single dose of Prozac should not hurt a healthy person. The possible side effects and risks of using Prozac in small doses in conjunction with tricyclic and tetracyclic antidepressants appear to be minimal. However, the use of Prozac with MAOI antidepressants such as Nardil, Parnate or Marplan is considered dangerous. Prozac taken by mistake with an MAOI could conceivably cause a toxic reaction with elevated blood pressure, nausea, vomiting, or shock. Immediate transport to an emergency ward is indicated if such symptoms follow. A patient switching from an MAOI to Prozac must wait at least two weeks. A patient switching from Prozac to an MAOI must wait at least five weeks. Failure to observe these precautions can result in severe toxic reactions and even death.

*24\22\4*

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*

THE FAT BLOCKER PROGRAM: THE DAIRY GROUP

(Milk, Yogurt, and Cheese): 2-3 servings (I prefer the nonfat varieties)—This group provides calcium, protein, vitamin D, and other nutrients that are needed for the growth and maintenance of strong bones and connective tissues. A lack of either calcium or vitamin D, which is needed for the proper absorption of calcium, leads to rickets (soft, malformed bones) in children and osteoporosis (hollow bones) in adults.

In recent years, the dairy group has received a lot of undeserved bad press. It’s been called everything from mucous producing to unnatural to health threatening. I’ve found none of these claims to be scientifically substantiated. In fact, the lack of dairy products (and resulting lack of calcium) seems to be a lot more threatening to the health. Adequate amounts of calcium are vital for children and adolescents who are actively building bones and for pregnant women who are supporting the growth of the fetal skeleton. Without it, the quality of the bone suffers, paving the way for osteoporosis later in life. In my 40 years of medical practice, I’ve seen many patients suffering from this disease. Their brittle, easily broken bones are constantly wracked with pain, making it extremely difficult to get around. Eventually, the victim is confined to bed. The confinement, in turn, brings on complications such as pneumonia and other diseases that prey on the inactive. Not only do osteoporosis sufferers tend to die more quickly than their peers, the quality of their lives is severely lessened by the disease. So remember what your mother used to tell you: «Drink your milk!»

One serving of the dairy group is equal to 1 cup of milk, 1 ½ ounces of natural cheese, or 1 cup of yogurt. Of course, dairy products all suffer one disadvantage for dieters; they contain a lot of fat. For example, most cheese gets as much as 80 percent of its calories from fat, and cream cheese gets 91 percent. You can always try nonfat cheese, and for certain purposes (such as very spicy pizza where the taste and consistency of the cheese is largely masked), nonfat cheese can be quite acceptable. But to eat a chunk of the stuff plain may seem to you like eating soft plastic or candle wax. So, instead, eat a small amount of the cheese you really like, a little less than you usually eat, and pull out the excess fat with an extra gram or 2 of Chitosan.

The same approach applies to skim milk, which is my favorite, the only kind I drink. If you really dislike it, and even the low-fat 1 percent milk is too watery for your taste, try 2 percent and a little Chitosan.

I do recommend nonfat yogurt. It tastes almost as delicious as ice cream, and it lets you save Chitosan for when you really need it.

Average calorie amount per dairy serving. Nonfat: 90; Low fat: 120.

*81\29\2*

SCIENTIFIC PROOF THAT THE FAT BLOCKER PROGRAM WORKS

I’ve had a great many positive experiences treating patients with the program I describe in this book. But even the most exciting clinical experience is stronger if it’s backed up by scientific studies. Let’s take a look at just a few of the many studies showing how fat reduction and the other elements included in my program reduce the risk of heart disease, stroke, cancer, diabetes, gallstones, kidney stones, hypertension, arthritis, and ulcers.

You can do it!
This program has worked for many of my patients, whether they’ve been chubby, rotund, obese, or just plain big. It can work for you, too! The beauty of this program is that it never seems overwhelming. Unlike other weight reduction plans, I am not asking you to develop whole new eating and exercise regimens overnight. If you find that you can adopt the entire program all at once, begin simply by making a minor reduction in your fat intake. Gradually add in the other elements of the program as you feel comfortable. And remember, Chitosan can help you achieve your weight-loss goals. In no time at all, you’ll find yourself on the road to losing weight and gaining health!

*64\29\2*

THE MIRACLE OF CHITOSAN: IS CHITOSAN TOO GOOD TO BE TRUE

Not according to the studies, to my clinical experience, and the experience of countless, delighted dieters. Here is a summary of the dietary facts:

♦ Chitosan is a completely natural fiber derived from the shells of shrimp and other crustaceans.

♦ Chitosan acts like a magnet, its positive charge attracting and holding onto negatively charged fat from the food you just ate.

♦ The indigestible Chitosan/fat gel passes through the intestines and is eliminated from the body.

♦ By pulling fats and bile acids out of the body, Chitosan also helps to reduce your blood fats, total cholesterol, and bad LDL cholesterol, while increasing the good HDL cholesterol that can protect against heart disease.

♦ Chitosan has been tested and found to be safe and effective in scientific studies.

By taking Chitosan before a meal, you can block the absorption of at least 3—and up to

6—grams of saturated fat for every gram of Chitosan consumed. I’ve been using it as part of my Fat Blocker Program for years. When combined with a healthful diet and a program of regular exercise, Chitosan is a safe and effective key to opening the door to successful dieting. You can immediately and easily cut back on your fat intake without drastically changing your diet, thanks to Chitosan, the fat magnet. Even better, you can use Chitosan as part of the Fat Blocker Program to lose weight, improve your health, and maintain lifelong eating and lifestyle habits that will keep you in vibrant health. Chitosan is found under a number of brand names in health food stores.Program to lose weight, improve your health, and maintain lifelong eating and lifestyle habits that will keep you in vibrant health. Chitosan is found under a number of brand names in health food stores.

*47\29\2*

FAT AND ARTHRITIS

Arthritis is a very common ailment, afflicting tens of millions of Americans. There are many types of arthritis, including rheumatoid arthritis, gouty arthritis, bursitis, systemic infections arthritis, and osteoarthritis. The most common form of the disease, osteoarthritis results from a breakdown of the cartilage that normally cushions the ends of the bones and prevents them from rubbing against each other and wearing away. If the cartilage does wear away, the result can be stiffness, pain, loss of joint mobility, and deformation of the joint.

There are many painkillers used to treat arthritis, though none are completely effective. These medicines can help with pain and inflammation, but many of them have side effects. A much simpler approach that I’ve prescribed with a great deal of success is to slim down. Although obesity does not necessarily cause osteoarthritis, the two often go hand in hand. There is a definite link between gaining weight and developing osteoarthritis, especially in the knees and ankles, which bear the brunt of the extra weight with each step. A large percentage of patients had gained weight shortly before the osteoarthritis began, and some 50 percent of those with the disease had been overweight for 3-10 years before the disease struck.11

The Fat Blocker Program has helped many of my arthritis patients get off their medicines while relieving pain and stiffness in their knee, hip, and ankle joints (as have the new

developments in arthritis treatment as described in The Arthritis Cure, cowritten by Brenda Adderly).

*29\29\2*

THE FAT BLOCKER PROGRAM: MIND BEING FAT

As Bob’s belly expanded, his life contracted. By his early thirties he was spending most of his time either working, playing with his computer, or lying on the couch watching television. «I really don’t mind being fat, Dr. Fox,» he explained when he first came to my office. «That’s just me. But when these chest pains started, I knew I had to do something. I’m really afraid I’m going to have a heart attack and die, because that’s what happened to
both my father and grandfather. They got fat and died of heart attacks before they were 50.»

Bob made the rounds of doctors’ offices, trying one medicine after another for his chest pains and elevated blood pressure. Both of these conditions were caused by his high-fat, high-cholesterol diet, his completely sedentary lifestyle, and the 150 extra pounds he carried in his «belly bib,» chest, and rear end. Meanwhile, he continued gaining weight. «The medicines aren’t doing it for me, Doctor. I don’t want to die, so I’ve got to lose
weight.»

I put him on the Fat Blocker Program, not sure if it would really work for someone that morbidly obese. To be on the safe side I also had him continue with the medicines for his heart and blood pressure. But as the weeks passed and Bob steadily lost weight, I began to relax. The pounds seemed to melt away, his chest pains disappeared, and both his cholesterol and blood pressure dropped back down toward safe levels. As his health improved, I gradually began phasing out his medicines. Finally, even his belly bib disappeared and we could actually see his belt again! He had lost 130 of that excess 150 pounds, bringing his weight down to a relatively safe (if slightly pudgy) 190.

Two years later, Bob was still at a normal weight and still healthy. «I think I ate because I was scared of dying, like my father and grandfather,» he told me. «Now that I’m at a normal weight, I’m not afraid of dying anymore so I’m not scarfing everything in sight. And I feel like grabbing a candy bar occasionally, but well, the Chitosan helps take care of that».

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