Automatic Sexual Chemistry
Routine screening of asymptomatic, sexually active adolescent females undergoing pelvic examination is recommended. Annual screening should be done for women age 20-24 years who are either inconsistent users of barrier contraceptives or who acquired a new sex partner or had more than one sexual partner in the past 3 months. II. Gonorrhea. Gonorrhea has an incidence of 800,000 cases annually. Routine screening for gonorrhea is recommended among women at high risk of infection, including prostitutes, women with a history of repeated episodes of gonorrhea, women under age 25 years with two or more sex partners in the past year, and women with mucopurulent cervicitis.
Ask the patient to describe any endocrine or neurological symptoms. Usually, patients give a history of slowly developing, progressive symptoms. They frequently complain of headaches, visual disturbances (blurred vision or double vision progressing to blindness), decreased sexual interest, menstrual irregularities, and impotence. Family members may report central nervous system (CNS) changes, such as anxiety, personality changes, seizure activity, and even dementia. Depending on tumor type, patients may describe weakness, fatigue, sensitivity to cold, and constipation.
Transurethral resection of the prostate (TURP) may be recommended for men with more advanced disease, especially if it is accompanied by symptoms of bladder outlet obstruction. This procedure is not a curative surgical technique for prostate cancer but does remove excess prostatic tissue that is obstructing the flow of urine through the urethra. The incidence of impotence following TURP is rare, although retrograde ejaculation (passage of seminal fluid back into the bladder) almost always occurs because of the destruction of the internal bladder sphincter during the procedure. Many men equate ejaculation with normal sexual functioning, and to some the loss of the ejaculatory sensation may be confused with the loss of sexual interest or potency. Also, a bilateral orchiectomy may be done to eliminate the source of the androgens since 85 of prostatic cancer is related to androgens.
With patch and gel systems the recommended beginning dose is 5 mg testosterone for adults smaller doses are recommended for some elderly males. Measurement of serum testosterone concentrations about 12 h after application after daily treatment for 7-14 days will provide information about adequate dosing. Then dosing adjustments can be made. Counseling of patients and their partners before beginning androgen replacement is recommended to help reduce or alleviate adjustment problems of increased sexual interest and performance.
Although aging brings biological changes that may dampen sexual interest in some people, the demands of daily life also shape older people's sexual desires or drives. Engaging in sex at any age requires an investment of time, emotion, and energy As for people in other age groups, older people's sexual drives may decline under the pressures of mental or physical fatigue, preoccupation with business, overindulgence in food or drink, physical illness, or fear of sexual failure. For some people, boredom within the relationship also may be a factor in a loss of sexual interest. Life events and major transitions often affect a person's interest in sex. Many older adults who have an active sex life say that sex feels as good or better than when they were younger. The changes that come with age, such as a man's taking longer to achieve orgasm, can provide an opportunity for couples to become more sexually compatible.Also, without the distraction and demands of children, or worries about...
To continue with the hormonal theme, we can begin by looking at beliefs about the distribution of female sexual interest during the menstrual cycle. Many researchers, in evolutionary biology, behavior, and physiology, have deduced that it must be the case in human females that peak sexual interest and desire occur at the same time as peak fertility. This conclusion is a simple extension of the hormonal determinism model from mice and dogs. While this may have the ring of a reasonable assumption, it is not supported by the clinical literature. Kinsey, for example, found that 59 of his female sample experienced patterns of fluctuation in their sexual desire during their cycle but only 11 experience a peak of sexual desire in mid-cycle, when they are most likely to be fertile.11 More recently, Singer and Singer, in a survey of studies, found that only 6-8 of women experience an increase in sexual desire around the time of ovulation. Most studies found peaks of sexual desire right before...
Many species of birds use song for courtship, and male birds primarily use this courtship display to attract female birds. G. Miller (2000) wondered if music in humans was also a means of courtship and if, like birds, there is a male preponderance. As I mentioned previously, Miller studied gender differences by comparing the recorded output of prominent jazz, rock, and classical musicians and found that men produced 10 times more music than did women. On the basis of this finding, Miller concluded that even in humans music continues to be primarily used by men as a courtship display to attract women.
If hypogonadism is identified as the underlying cause of fatigue, exogenous testosterone or synthetic anabolic steroids may be administered (Dufour et al., 2005). However, patients receiving this treatment are susceptible to anabolic and androgenic effects such as increased heart rate, increased blood pressure, and hirsutism. Testosterone therapy may take the form of injections, pills, patches, gels, or creams. This treatment has been shown to have a beneficial effect on not only fatigue but also sexual interest, appetite, wasting, energy levels, and even concomitant depression. It
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