Sexual Disorders

Have you ever had trouble making love to your partner? Was your sexual experience an unpleasant one? Have you ever had embarrassing cravings for unnatural sex? Do you feel ashamed of your own sexual organ?

Many people experience sexual disorders. Still considered a taboo, most people prefer not to discuss their shame and rather opt to suffer in silence. Therefore, allow me to shed some light on this for the good of everyone.

Sexual disorders cover a wide range of aetiological factors and causes, notably the main groups being psychogenic and organic. However, in this article only the psychogenic causes will be discussed.

Part 1: Sexual Dysfunction

Sexual dysfunction covers the various ways in which an individual is unable to participate in a sexual relationship as he or she would wish. There may be lack of interest, lack of enjoyment, failure of the physiological responses necessary for effective sexual interaction (e.g. erection), or inability to control or experience orgasm.


Something keeping you from having good sex?

Lack or loss of sexual desire:
Loss of sexual desire is the principal problem and is not secondary to other sexual difficulties, such as erectile failure or dyspareunia. Lack of sexual desire does not preclude sexual enjoyment or arousal, but makes the initiation of sexual activity less likely. This Includes frigidity (female impotence), and hypoactive sexual desire disorder.

Sexual aversion:
The prospect of sexual interaction with a partner is associated with strong negative feelings and produces sufficient fear or anxiety that sexual activity is avoided.

Lack of sexual enjoyment:
Sexual responses occur normally and orgasm is experienced, but there is a lack of appropriate pleasure. This complaint is much more common in women than in men. This includes anhedonia (absense of sexual pleasure).

Failure of genital response:
In men, the principal problem is erectile dysfunction, i.e. difficulty in developing or maintaining an erection suitable for satisfactory intercourse. If erection occurs normally in certain situations, e.g. during masturbation or sleep or with a different partner, the causation is likely to be psychogenic. Otherwise, the correct diagnosis of nonorganic erectile dysfunction may depend on special investigations (e.g. measurement of nocturnal penile tumescence) or the response to psychological treatment.

In women, the principal problem is vaginal dryness or failure of lubrication. The cause can be psychogenic or pathological (e.g. infection) or estrogen deficiency (e.g. postmenopausal). It is unusual for women to complain primarily of vaginal dryness except as a symptom of postmenopausal estrogen deficiency. This Includes female sexual arousal disorder, male erectile disorder, and psychogenic impotence.

Orgasmic dysfunction:
Orgasm either does not occur or is markedly delayed. This may be situational (i.e. occur only in certain situations), in which case aetiology is likely to be psychogenic, or invariable, when physical or constitutional factors cannot be easily excluded except by a positive response to psychological treatment. Orgasmic dysfunction is more common in women than in men. This Includes inhibited orgasm (for both male and female), and psychogenic anorgasmy.

Premature ejaculation:
The inability to control ejaculation sufficiently for both partners to enjoy sexual interaction. In severe cases, ejaculation may occur before vaginal entry or in the absence of an erection. Premature ejaculation is unlikely to be of organic origin but can occur as a psychological reaction to organic impairment, e.g. erectile failure or pain. Ejaculation may also appear to be premature if erection requires prolonged stimulation, causing the time interval between satisfactory erection and ejaculation to be shortened; the primary problem in such a case is delayed erection.

Nonorganic vaginismus:
Spasm of the muscles that surround the vagina, causing occlusion of the vaginal opening. Penile entry is either impossible or painful. Vaginismus may be a secondary reaction to some local cause of pain, in which case this category should not be used.
This includes psychogenic vaginismus.

Nonorganic dyspareunia:
Dyspareunia (pain during sexual intercourse) occurs in both women and men. It can often be attributed to a local pathological condition and should then be appropriately categorised. In some cases, however, no obvious cause is apparent and emotional factors may be important. This category is to be used only if there is no other more primary sexual dysfunction (e.g. vaginismus or vaginal dryness). This includes psychogenic dyspareunia.

Excessive sexual drive:
Both men and women may occasionally complain of excessive sexual drive as a problem is its own right, usually during late teenage or early adulthood. When the excessive sexual drive is secondary to an affective disorder or when it occurs during the early stages of dementia, the underlying disorder should be coded. This includes nymphomania (excessive sexual impulse in female), and satyriasis (excessive sexual impulse in male).

Part 2: Abnormal Sexual Preference, Paraphilia

Paraphilia is a term that describes a family of persistent, intense fantasies, aberrant urges, or behaviors involving sexual arousal to nonhuman objects, pain or humiliation experienced by oneself or one's partner, children, or nonconsenting individuals or unsuitable partners.

Exhibitionism:
The recurrent urge or behavior to expose one's genitals to an unsuspecting person. Can also be the recurrent urge or behavior to perform sexual acts in a public place, or in view of unsuspecting persons.


Exhibitionism; cartoon of flasher.

Fetishism:
The use of inanimate objects to gain sexual excitement. Partialism refers to fetishes specifically involving nonsexual parts of the body.

Frotteurism:
The recurrent urges of behavior of touching or rubbing against a nonconsenting person.


Frotteurism; man grabbing girl's behind.

Paedophilia:
The sexual attraction to prepubescent or peripubescent children.

Sexual masochism:
The recurrent urge or behavior of wanting to be humiliated, beaten, bound, or otherwise made to suffer for sexual pleasure.

Sexual sadism:
The recurrent urge or behavior involving acts in which the pain or humiliation of a person is sexually exciting.

Transvestic fetishism:
A sexual attraction towards the clothing of the opposite gender.

Voyeurism:
The recurrent urge or behavior to observe an unsuspecting person who is naked, disrobing or engaging in sexual activities, or may not be sexual in nature at all.

Other rarer paraphilias include telephone scatalogia (obscene phone calls), necrophilia (corpses), partialism (exclusive focus on one part of the body), zoophilia (animals), coprophilia (feces), klismaphilia (enemas), urophilia (urine), emetophilia (vomit).

Part 3: Sexual Disorientation

Homosexuality:
Homosexuality refers to erotic attraction, predisposition, or activity, including sexual congress, between individuals of the same sex, including gays and lesbians.

Transvestism:
The practice of dressing or masquerading in the clothes of the opposite sex; especially the adoption of feminine mannerisms and costume by a male.

Transsexualism:
The desire to change one's anatomic sexual characteristics to conform physically with one's perception of self as a member of the opposite sex.


Do you have an identity crisis?

Well, I guess if you suffer from any of the disorders above, my advice is: go see a shrink or psychiatrist, or admit yourself into a mental hospital and get some serious help!

Enjoy sex! Play safe!

Gallstones

Have you ever heard of medical cases where people talked about having stones, or specifically gallstones, extracted from their bodies?


Gallbladder opened to show numerous gallstones.

In medicine, gallstones are crystalline bodies formed in the gallbladder and the common bile duct by aggregation of bile components. Bile is the greenish-brown fluid secreted by your liver and is stored in the gallbladder. It is needed for emulsion and digestion of fat.


The green organ indicates the gallbladder in this schematic.

There are 2 major types of gallstone: cholesterol and pigment stones.

Cholesterol stones:
They are usually greenish-yellowish in colour, large and often solitary. They are made primarily of cholesterol. They account for 80% of gallstone cases.


Cholesterol stones

Pigment stones:
They are small, dark stones, usually friable and irregular. They are made of bilirubin and bile salts that are found in bile. They account for 20% of gallstone cases.


Pigment stones

Unlike infectious diseases like tuberculosis, you do not get gallstone disease from another person. This disease is caused within the person himself due to factors like lifestyle and habits. If you get this disease, it your fault.

Aetiology:
Gallstones develop when bile contains imbalance amount of cholesterol and bile salts. Two other factors are important in causing gallstones. The first is how often and how poorly the gallbladder contracts to overconcentrate and contribute to gallstone formation. The second factor is the presence of proteins that either promote or inhibit cholesterol crystallization into gallstones.

Researchers believe that gallstones may be caused by inherited body chemistry, body weight, gallbladder motility (movement), and perhaps diet.

Risk factors:
Obesity, age, type IV hyperlipidaemia, cirrhosis, smoking, being female, and parity (having given birth).

Prevalence:
8% of those over the age of 40, where 90% of these people remain asymptomatic.

Gallstone disease cause cholecystitis by obstructing bile flow, leading to concentration and stasis of bile, and promoting infection from intestinal microorganisms.

It results in cholecystitis, that is the inflammation of the gallbladder.


Cholecystitis is a painful disease!

Cholecystitis manifests itself in the following ways:

Symptoms:
Severe and constant pain at the right upper quadrant (RUQ) of the abdomen, fever, vomitting, nausea and anorexia (loss of appetite); which may lead to jaundice and diarrhoea.


Pain at the right upper quadrant in cholecystitis.

What should you do?

Consult a physician immediately, unless you are fond of the severe and constant pain.


Always trust your doctors.

Your physician would then examine you physically. Special and specific signs are performed to confirm cholecystitis. Signs are diagnostic examinations founded by great physicians of the past and are named in their honour.

Murphy's sign:
This is the standard sign of cholecystitis worldwide. Pain is felt during inhalation or coughing when the physician palpates your RUQ due to the inflammation of the gallbladder.


Murphy's sign: Pain during deep palpation.

However, as stated in my previous post, Russians emphasise greatly on the importance of practical skill. Therefore, Russian physicians test not one, but several other signs.

Boas' sign:
Increased sensitivity below the right scapula.

Kalk's sign:
Pain during percussion on area of gallbladder.

Ker's sign:
Pain during simultaneous inhalation and palpation on area of gallbladder.

Kurvuasie's sign:
Enlarged, distended gallbladder is felt during palpation.

Mussi-Georgievsky's sign:
Pain during palpation between pedicles of the sternocleidomastoid muscle of the right side.

Ortner's sign:
Pain during striking of the right costal arch by ulnar margin of the hand.

Razba's sign:
Pain during light punches of the right costal arch.

Shetkin-Bloomberg's sign:
Pain after sudden release of deep palpation of RUQ.

Vasilenko's sign:
Pain during percussion at peak of inhalation on area of gallbladder.

Zaharin's sign:
Pain during moderate stroking of gallbladder area.

Your physician would then perform several hi-tech diagnostic tests on you.

Diagnostics:
Blood taking to detect changes.
Ultrasonography to look for thickened gallbladder walls and gallstones.
Hepatobiliary scintigraphy to assess ability of gallbladder to expel bile.
Abdominal X-ray to look for gallstones.

Patients confirmed with gallstones are usually referred from your physician to surgeons.


Shiny scalpel. Gonna cut him up.

Recovery from this disease is possible with proper treatment, however, usually not without invasive intervention. Depending on the severity of the disease, patients are operated on with different surgical procedures.


Laparoscopic cholecystectomy as seen through laparoscope.

Treatment:
Antibiotics for preoperative preparation.
Oral ursodeoxycholic acid to dissolve gallstones.
Extracorporeal shock wave lithotripsy, to break up gallstones.
Laparoscopic cholecystectomy, using endoscope.
Traditional open surgical cholecystectomy.


X-ray during laparoscopic cholecystectomy

Surgery should be performed as soon as possible; delay in treatment will increase chances of morbidity, mortality and complications.

Remember, this disease is caused by unhealthy lifestyle and habits. So stay healthy, or suffer!

Tuberculosis

Have you ever thought of the possibility of contracting tuberculosis?

Do you even know what tuberculosis is?

Tuberculosis (TB) is one of the leading infectious cause of death worldwide, with 2 billion infected people and causing 3 million deaths a year.


Worldwide cases per 100k; red >300, orange 200-300, yellow 100-200, green 50-100, gray <50.

With that figure in mind, shouldn't you be concerned about this disease?

Getting infected:
It is very easy to contract TB. Simply by sharing the same environment with a person who suffers from TB is a risk factor, and talking to that person almost guarantees that you will contract it. This is because TB is an airborne disease.


The Sneeze of Death: sprinkle pepper at face for instant effect.

So, what causes TB?

Aetiology:
TB is primarily caused by the organism of Mycobacterium tuberculosis, and less commonly by Mycobacterium bovis by drinking unpasteurised milk.


Mycobacterium tuberculosis under the electron microscope.

Up to 80% of cases of tuberculosis are confined to the lungs, or pulmonary TB, and the rest of the cases being extra-pulmonary TB. Pulmonary TB is further divided into primary TB and post-primary TB (ie, reactivation of TB).


Chest X-ray showing TB of lungs.

How would you know if you have TB? If you have fulfilled some of the criteria below, you are at risk.

Risk factors:
You had unprotected contact or interaction with a TB patient.
You suffer from a serious disease like AIDS.
You require chemotherapy which suppresses your immune system.


Wearing protective face masks can prevent infection and spreading of TB.

When you're infected, you might exhibit symptoms characteristic of TB.

Symptoms:
Fever, general weakness, sweats, anorexia (poor appetite), cough, sputum, erythema nodusum (painful nodes on legs), or phlyctenular conjunctivitis (red nodes on cunjunctiva).

What should you do?


Always trust your doctor.

Consult a physician immediately. Not only are you sick, you could be a health hazard to others.

Your physician would then perform several hi-tech diagnostic tests on you.

Diagnostics:
Sample taking, which includes blood, urine, sputum, pus and pleural fluid.
Chest X-ray, to search of visual signs in your lungs.
Bronchoscopy, to look into your lungs with an endoscope.
Biopsy, to confirm TB lesions in your lungs.
Immunologic tests, specifically the Mantoux-Tuberculin test, which requires patients to be injected with TB antigen under the skin, in which a diagnostic skin induration would form a few days later.


The Mantoux-Tuberculin test.

Malaysians usually get their first Bacillus Calmette-Guérin (BCG) vaccine shot at 12 years old. However, this form of immunisation lasts about 5 years. Further immunisation would be required.


Skin induration of less that 4 mm is considered a negative reaction. New BCG shot is required.

Luckily, due to the advent of modern science, survival from this disease is possible with proper treatment, which is in the form of medical therapy. Depending on the severity of the disease, patients are prescribed drugs in different regimes and doses, and treatment for the most common form is as below.

Treatment:
Rifampicin - 600 mg PO, thrice a week.
Isoniazid - 900 mg PO, thrice a week.
Pyrazinamide - 2.5 g PO, thrice a week.
Ethambutol - 30 mg/kg PO, thrice a week.
Streptomycin - 1 g IM, once a day.

Treatment of tuberculosis is of long duration up to 9 months. Any breach of compliance of treatment may result in reactivation of the disease, or post-primary TB.

However, taking drugs of any kind are almost never without adverse effects, just as these ones.

Drugs and its adverse effects:
Rifampicin - Hepatitis, orange discolouration of urine and tears
Isoniazid - Hepatitis, neuropathy
Pyrazinamide - Hepatitis, arthralgia
Ethambutol - Optic neuritis
Streptomycin - Ototoxicity


Anti-TB chemotherapy drugs.

Therefore, to counter the negative effects of these drugs, it is advisable to take adequate vitamin B, particularly B6 (pyridoxine) throughout the entire treatment.


Take adequate vitamin B6 during treatment.

At the end of this post, I hope you're enlightened! Stay healthy!