The Health Blog

As noted previously, if left untreated, the lesions eventually disappear on their own, but the process may take several months. To speed up this process, there are two treatment options. The first is freezing the lesions with liquid nitrogen—which is also the standard treatment for another sexually transmitted skin infection, genital warts. Another common treatment for warts, topical liquids such as podophyllin (10-25% solution) or trichloroacetic acid (80-90% solution), can be used either alone or in addition to the liquid nitrogen. These treatments basically destroy the virus as well as the skin cells containing the virus. The second treatment option is to nick the skin of the lesions with a sterile needle and then express the central core of virus.

This is easier if the lesions are larger. The lesions tend to be well vascularized, so bleeding can occur with this method. Patients can be taught to perform this procedure themselves.

Treatment may not be successful in people with such underlying immune system problems as AIDS.

The lesions are usually not red, tender, or filled with pus. If these features are noted, it may be a sign that there is a secondary bacterial infection, most often with the common bacteria found on the skin, such as staphylococcus and streptococcus. Such infections occur in about 40 percent of those with molluscum infection. If a secondary bacterial infection is suspected, antibiotic treatment may be necessary.

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As discussed previously, the classic symptoms of blisters and ulcers do not occur in everyone who has herpes. If symptoms do develop, however, they usually do so within two to twenty days of first infection. After infection with herpes, whether or not a person develops symptoms, the virus moves from the skin into the nerve endings that supply the area of the skin that was infected. It migrates along the nerve endings to the nerve root body, or ganglion, which is near the spinal cord. Here the virus remains quiet, or dormant, and then periodically migrates back out to the surface of the skin.

When the virus migrates back to the surface of the skin, a person may develop symptoms, such as a sore or itching or tingling on the skin, or he or she may remain completely symptom free. The condition in which there are symptoms is called an outbreak; when the virus comes to the surface of the skin and doesn’t cause symptoms, the condition is referred to as asymptomatic or subclinical shedding of the virus. Sometimes there is a warning that the virus is reactivating; this warning, called a prodrome, may consist of itching, tingling, or pain in the area where the outbreak takes place, but before there is any evidence on the skin. However, not everyone experiences prodromes.

Everyone who has oral or genital herpes, whether type 1 or type 2, will shed without symptoms at some point. How often this occurs varies from person to person. Why some people shed more than others, and why some people have more outbreaks than others, is not clear.

Two things are clear, however: people who are newly infected (for less than a year) have more asymptomatic shedding than those who have been infected for a longer time, and people who experience more frequent symptomatic outbreaks also tend to shed the vims more often without symptoms than those who rarely have outbreaks.

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This bacterial infection is treated with antibiotics. In the United States, the first choices are doxycycline or trimethoprim-sulfamethoxazole. Ciprofloxacin and erythromycin are second choices.

Although treatment is only successful if it is continued until the infection has been cleared—usually in about three weeks—and the infection may recur if the antibiotics are stopped sooner, it is sometimes difficult for various reasons for people to take the full course of antibiotics. Studies are under way to determine whether medications such as azithromycin, which remain in the body longer (and thus require fewer doses to be taken), are a reasonable alternative.

Scarring may persist despite adequate treatment, but it is usually minimal if medical attention is sought early in the infection. If a secondary bacterial infection develops on top of the donovanosis, it may need to be treated with different antibiotics.

Treatment may not be as successful in a person who has a compromised immune system, such as one with HIV infection. In this case, the medications are taken for a longer period.

All sexual partners of a person with donovanosis for a period of up to sixty days before the infected person developed symptoms must be treated with antibiotics, even if they are symptom free.

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As enzymes go, PSA is kind of a tough guy. Like a feisty slugger always looking for a fight, it actively attacks proteins at every opportunity. In the bloodstream, however, PSA is usually restrained by inhibitors that prevent it from breaking down proteins; like a member of a chain gang, it is tied up, or bound.

In one promising new area of research, scientists are working to characterize the forms of PSA in the bloodstream. Is the PSA bound to the inhibitors, or is it on the loose—is it free? Currently, the tests doctors use to measure PSA detect both the bound and unbound molecules. But it might be helpful if we could tell which was which; new evidence indicates that the amount of bound PSA in the blood may be higher in men with prostate cancer than in men with BPH. If this proves to be true, one day soon it may be possible to distinguish between the PSA arising from prostate cancer and the PSA arising from BPH by measuring both its bound and free forms.

In the future, we’ll see a new, more specific generation of PSA assays, tests capable of quantifying different forms of the molecule in the bloodstream. Such tests may provide useful clinical information, not only for diagnosis of prostate cancer, but also for evaluation and follow-up.

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Believe it or not, diet even has an effect on hormones such as testosterone. A diet that’s low in fat and high in fiber lowers the amount of testosterone in the blood, and hormones such as testosterone play a big role in the growth of prostate cancer. One study found blood testosterone levels in young black men to be about 15 percent higher than those of young white men; a similar study found that Dutch men had higher levels of male hormones than Japanese men. Also, studies of American men have found that they have higher levels of DHT (dihydrotestosterone) metabolites than Japanese men. (DHT is the active form of male hormone in the prostate.) Some investigators interpret this to mean that more DHT may be the cause of the cancer. However, DHT is produced by the secondary organs of reproduction (such as the prostate), and Oriental men tend to have smaller hair follicles and prostates. Which is the cause and which the effect? The lower DHT may simply reflect the fact that Japanese men have inherendy smaller secondary organs of reproduction, which contribute less DHT to the circulation.

Other studies found that black and white American men had higher amounts of these male hormones in their urine than black South African men, and that the level of these hormones had a lot to do with diet. When the black South African men ate a Western diet, instead of their usual vegetarian diet, their hormonal levels went up. And when black American men ate a vegetarian diet, their hormonal levels went down. Again, this seems to be more proof that a low-fat, high-fiber diet can lower any man’s risk of prostate cancer.

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Incest is sexual activity between members of the same family. Sex play between children in the same family is common and is not usually considered to be abusive. Exploratory sex play between cousins and brothers and sisters is not usually physically or psychologically damaging unless one child is older and bigger than the other uses force.

Incest between adults in the same family or between adults and children in the same family is illegal. It includes all kinds of sex play including asking children to undress. Incest usually occurs between a man and a young girl who is related to him. Women are also known to commit incest with younger members of their families.

Incest is committed against infants, young children, teenagers and young adults. Older children may allow themselves to be victimized to protect a younger sibling from being victimized. In many cases mothers know what is happening when fathers or stepfathers are the offenders and their daughters are the victims, but they may remain silent because they believe they are unable to intervene. These relationships often cause profound shame and guilt and can seriously affect children for the rest of their lives.

In most states, sexual contact or marriage between blood relatives is against the law. But some states allow marriage between first cousins.

Pedophilia is a psychological condition in which an adult is sexually aroused only by children. Using children for sexual arousal crime in every state. Most pedophiles are men who were sexually abused as children. It is very difficult for them to control their urges. Therapy is not always successful, and repeat offenses are common

Many pedophiles control their sexual urges with chemical castration. They receive weekly injections of Depo-Provera to reduce sexual desire. California offers this option to any first time sex offender who has molested a child under 13. If the man commits a second offense, the law requires either chemical or surgical castration. Removing the testicles stops nearly all testosterone production. Although it is not a foolproof way of preventing further sexual abuse, it permanently reduces sexual desire. Chemical castration is used in some parts of Europe and has decreased the rate of repeated sex offenses by treated men from 100 percent to 2 percent.

A new federal law, called Megan’s Law, went into effect in 1997. It requires convicted pedophiles who have been released from jail to register with the police every 90 days. They must provide a blood sample for identification. Police must contact citizens to alert them to the presence of a pedophile in their community. Lifetime supervision by parole officials is mandatory.

Seven states now allow prison authorities to put dangerous sex offenders in mental hospitals without their consent after they have served their full sentences. This has raised legal questions about whether people who have already been punished for sexual crimes and who are not considered officially “mentally ill” should continue to be held in this way The U.S. Supreme Court will rule on this matter in 1997.

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Molluscum Contagiosum

Hundreds of thousands of cases of the virus molluscum contagiosum (mo-LUS-kum con-TAY-gee-OH-sum) are diagnosed every year. The virus is often transmitted by nonsexual intimate contact. In children, it may be spread by more casual contact and is often found on various parts of the body, such as the abdomen.

Common Symptoms: Small, pinkish-white, waxy, round, polyp like growths in the genital area or on the thighs. There is often a tiny depression in the middle of the growth. Symptoms usually appear between two and 12 weeks after infection—but it can take years.

How Molluscum Contagiosum Is Spread: Vaginal, anal, and oral intercourse, as well as other intimate contact.

Diagnosis: Microscopic examination of tissue taken from the sore.

Treatment: Growths may be removed with chemicals, electrical current, lasers, or freezing.

Protection: Condoms may offer some protection, but the virus may “shed” beyond the area protected by the condom.

Pelvic Inflammatory Disease (PID)

PID is a condition that harms a woman’s reproductive system. PID occurs throughout the pelvic area, in the fallopian tubes, the uterus, the lining of the uterus, and the ovaries. Treated or untreated, PID can lead to sterility, ectopic pregnancy, and chronic pain. The more episodes of PID a woman has, the greater are her chances of becoming sterile. PID is not always the result of a sexually transmitted infection, but in many cases it is. The sexually transmitted infections that most commonly cause PID are gonorrhea and chlamydia. More than 1 million new cases of PID are diagnosed every year in the United States. It is believed that millions of others go undiscovered.

Common Symptoms

• fever, chills

• nausea, vomiting

• pain during intercourse

• pain in the lower abdomen

• spotting and pain between menstrual periods or during urination

• unusually long or painful periods, and unusual vaginal discharge

Diagnosis

• pelvic exam

• laboratory examination of vaginal and cervical secretions

• laparoscopy, in which an optical instrument is inserted through a small cut in the navel to look at the reproductive organs

Symptoms can be confused with those of appendicitis and other infections. Diagnosis can be difficult if patients are too embarrassed to admit sexual activity.

Treatment: Antibiotics, bed rest, and sexual abstinence. Surgery may be required to remove abscesses or scar tissue, or to repair or remove reproductive organs.

Protection: Condoms offer very good protection against the sexually transmitted infections commonly associated with PID.

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We all have a mental image about how we look. This mental picture is part of our body image, and it has a great influence on our sexuality and our sex lives. Our feelings about our bodies form the other part of body image.

A good body image is a gift that our families and friends help give us. It can allow us to feel secure about our sexuality and our sex lives, whether we’re big or small, fat or thin, muscular or soft, light or dark. A poor body image is a handicap that we may receive from families and friends who ridicule or humiliate us and give us negative feelings about our sex organs and masturbation. Poor body image can make us feel insecure about our sexuality and our sex lives, no matter how beautiful we are.

Sexual inhibitions can make us feel bad about our bodies, and poor body image can magnify our sexual inhibitions. They form a vicious circle. Each intensifies the other. Just as our families and friends contribute to our sense of body image with their approval or disapproval, so does the society in which we live. Television and other media play a crucial role in reflecting and establishing social norms about body image. The standards it sets for women and men are impossible for most of us to meet.

Popular magazines show “perfect” women and men and include articles on how to achieve a “perfect” body. Advertisers barrage us with millions of images of what it is to be beautiful and sexy. A healthy, fit, and trim body is a wonderful thing, but the media message is that beauty does not include people with disabilities, unwanted facial hair, acne, soft bellies, or small breasts. In fact, there are thousands of beautiful, sexy, and beloved women and men in the world with disabilities, unwanted facial hair, acne, soft bellies, and small breasts.

We are likely to forget that fact, though, when we compare ourselves to the images in film, on television, and in print. Advertisers benefit from the insecurities we feel about our bodies as we compare ourselves to the standards they set. The more we become insecure about our image, the more likely we are to buy a product to cure our “problem.” And the more likely we are to become sexually inhibited.

Although there is no single cause, sexual inhibition and poor body image can contribute to serious eating disorders—anorexia, bulimia, and binge-eating disorder. These disorders are attempts some people make to take control of their lives, especially their sexuality. Although much more common in women, eating disorders are increasing among young men. Women with anorexia go without eating to achieve what they believe is socially approved thinness. Unfortunately, they come to believe they can never be thin enough and starve themselves. One out of five dies of heart failure or other complications associated with malnutrition. Anorexic women develop many other serious life-threatening conditions. They may also lose their menstrual periods, fertility, breast tissue, vaginal lubrication, and sexual desire.

In order to achieve thinness, bulimic women and men binge on large amounts of food and then purge themselves by fasting for long periods, using laxatives, or inducing themselves to vomit.

Binge-eating is compulsive overeating. It is done to relieve stress and anxiety, including sexual anxiety. Becoming obese may heighten sexual inhibitions and provide an excuse to avoid sexual contact.

Eating disorders can be treated with psychotherapy and professional medical guidance. Even after an eating disorder is put under control, however, a person may struggle with the consequences for a lifetime.

While most of us will not develop a serious eating disorder, worrying about our bodies is very common and can cause sexual inhibition and conflict. Are we pretty enough for the partner we desire? Are we handsome enough? Are we the right size and shape? Are we tall enough? Are we too tall? Are we the right color? Are our genitals attractive? We can make ourselves very unhappy with these concerns. They can also inhibit our sexual pleasure if they linger in our minds during sexual activity.

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More and more authorities on child development are accepting intimate and even sexual encounters as a normal part of the maturational process. No longer do we feel that early discovery of genital differences, child-child sex play, or even a single occurrence of sexual molestation will have lasting ill effects on a child in a stable pattern of family-community experiences. Healthy children are not as easily upset by sexual experiences as some theorists would have us believe. Feeling the genitals of another child, getting a glimpse of the parent undressed, or a look at a “girly” magazine does not seriously disturb the average child.

There is no one reaction, for instance, to the discovery of genital differences of the sexes. Children generally accept the differences between the sexes with composure though some have a feeling of strangeness, surprise, curiosity, disappointment, or humor. There are children who are somewhat disturbed; they feel that something is “wrong” with what they have seen, something that should not be. Acceptance is mingled with the feeling that reality has somehow not come up to expectations. Some boys, thinking in terms of the external genitalia in the male and their absence in the female, assume that girls have lost an existing penis. Some girls also think that “something is wrong” with what they see.

Young people today generally recall their childhood sexual encounters, including their sex education, as having been almost totally inadequate in preparing them for experiences with the opposite sex during adolescence and adulthood. If the child received any formal sex education from parents or from the school, it usually consisted of a certain amount of cautious information about anatomy and the mechanisms of reproduction. It is too early to say if the programs of sex education for children being introduced in the schools today are effective.

Parents who go to great effort to protect their child from the normal intimate, sexual experiences of childhood may unconsciously do the very things that are designed to defeat their purposes. Frustration or the withholding of positive reinforcement of intimacy needs may result in an increase rather than a decrease in the motivation to satisfy such needs. It is a moot question. Is it the repressive rather than the permissive parents who contribute most to the high level of interest in sex and the high sexual-erotic content of our culture? Those who support the repressive sexual socialization of children do so largely out of fear that children will misbehave sexually if sensory, affectional, and sexual appetites are not repressed from infancy. It is true also that the clinical literature provides ample evidence of unwise or disturbed parents who willingly or unwillingly encourage and reinforce deviant and antisocial sexual behavior in their offspring. It is true also that because of varying types of upbringing, individuals differ in the extent to which they are able through self-restraint to tolerate delay of reward. The child learns whether taught or not. If not presented with models, he or she will find models. Attempts to postpone sexual socialization will only be partially successful and the models chosen could be less than adequate. Given the nature of human personality, the socialization process will continue in some manner or other from birth to maturity. One can conclude from Broderick’s research on intimacy patterns of children that intimate associations and attachments at all ages in infancy and childhood are necessary to sensory, affectional, and sexual maturity.

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In neonatal life, sex hormones circulating in the bloodstream are at a high level compared to that of later infancy and childhood. Prior to birth, hormone function depends upon maternal and placental endocrine activity, and upon the endocrine activity of the fetus itself. The period after birth is one of rapid transition from maternal and placental dependence to autonomous functioning.

From birth until the first seven to twelve months of age, there are sex differences in hormone concentrations. Testosterone levels are high in both boys and girls but higher in boys. In boys, there is a testosterone peak by the second or third month, followed by a gradual decrease to prepubertal levels by one year. In girls, the testosterone level rapidly declines to the prepubertal level by the second week of life. There is an increase in lutenizing hormone (LH) and follicular stimulating hormone (FSH) in both sexes during the first year, but girls have higher levels of FSH and boys of LH. Estrogen levels have not yet been ascertained for boys or girls.

Differences in endocrine function present at birth and in the neonatal period are not known to be related to psychosexual differentiation or to any aspect of behavioral development. Precise methods of measuring steroid levels by radioimmunoassay determinations are relatively recent; behavioral correlation studies have not been undertaken.

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