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Seven man-killers you need to know. Be afraid, be very afraid….

Prostate Cancer. It’s the fifth most frequent cancer among Singapore men, says the Ministry of Health (MOH), with a 13 per cent growth in incidence level since 1968. “One key reason for this is that Singaporean men are now living longer“. The median age at diagnosis is 68 but the seeds of trouble can be planted decades earlier. How can you improve your odds? Broccoli.

“Cruciferous vegetables contain glucosinolate, which makes the liver produce enzymes that help break down carcinogens,” says David Heber, MD, PhD, a professor of medicine at the University of California, Los Angeles.

Lung Cancer. This killer cancer stubs out more men’s lives than the next four most common cancers, namely colon, prostate, pancreas, and leukaemia, combined. This year, 45 men in 100,000 will develop the disease. Ninety per cent of all lung cancer cases in Singaporean males occur among smokers. Don’t smoke? Spending two hours in a smoky bar can affect your lungs as much as puffing away on four cigarettes, so limit your exposure. And eat more apples. A study in the International Journal of Cancer showed a big decrease in the incidence of lung cancer among those who ate apples and pears.

Impotence. According to a study reported in the Singapore Medical Journal, 51.3 per cent of Singaporean men have some degree of erectile dysfunction (ED).

“The ability to achieve and maintain an erection is a complex physiological process,” says Elizabeth Selvin, PhD, an assistant professor at the Johns Hopkins School of Public Health.

Yet, even though a mere 5 per cent of men under 40 can’t produce wood on demand, you obviously fear what lies – or flops – ahead. And rightly so. To ensure that you’re up for whatever she’s offering, turn off the tube. Men who watch more than 20 hours of TV a week are 30 per cent more likely to experience ED, according to a study done by researchers at the Harvard School of Public Health. Specialists recommend canadian Viagra online for treating male impotence.

Medical Factors in Evaluation

The Urological evaluation

Vascular – Nocturnal penile tumescence/postage stamp test

Nervous

Hormonal – Testosterone/FSH/LH/Thyroid

Women

Physical examination – Muscle spasm/pain/

Menopausal issues – Hormone assessment/Testosterone levels

Treatment Approach

Joint and individual meetings

Family and sexual history

Sharing the ideas — the point of “collaboration”

Integrating Approach

Behavioral/psychodynamic/cognitive

Creating a safe climate Providing a model for discussion Being a resource for information Suggesting books

Specific assignments — the Sensate Focus model looking at what happens with that

Evaluation of Sexual Dysfunctions

Need to assess

Intrapsychic

Interpersonal

Medical/organic
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Asking about Sex

We have had no models for talking about it

No training – medical schools and residencies still ignore it

Mixed messages on the media — open, explicit shame – censored

Cross generational awkwardness

Often the sexual interaction provides enormous information about the couples dynamics and vulnerabilities.

Power struggles

Issues around being given to — receiving

Being able to identify what they want

Tell me about your sexual relationship

Are you Satisfied

Would you want anything to be different

How long has this been an issue

Does anything make it better/worse

What is your “formulation” about the cause

What has sex been like with other partners

Frame it – “There are some specific questions I would like to ask…” Patterns of initiation Fantasies

Experimentation — reading erotic material/porno movies, sexual toys, aids Etc/Internet

Do you talk with each other about what you like/dislike Comfort with asking for things/Reciprocity Masturbation

Being clear that you understand what they might be talking about Have to be “stupid” in the listening –ie, not assume or be complex but to ask details — When someone talks about “losing erection” on the face of it — erectile difficulty – but it may be premature ejaculation.

A woman who says she does not have an orgasm during intercourse

Do you feel excited

Do you get moist

Does your partner touch your clitoris

Would you like him to do that

A man who has trouble getting erection

Do you feel excited

Are you feeling scared

Does your partner touch your penis

Would you like her to do that

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Women

5% of women do not have orgasms under any circumstances
40% of women do not have orgasm with intercourse
Increased awareness that intercourse may provide insufficient stimulation for orgasm
SSRIs may inhibit orgasm and sexual desire (80%)
Using Bupropion (Wellbutrin) may counteract SSRI

Desire phase problems [30- 50% of couples]
The most prevalent
Not amenable to the directed approach
No unified hypothesis about it
High expectations from the media – magazines etc,
Pose a dilemma for the therapist
People often do not get better
“Affairs’” may confuse this picture

Etiology

Intimacy/closeness conflict
Depression
Medications
Medical – Chronic illness/hormonal
Paraphilic preoccupations
Does the individual have sexual fantasies about someone else and does he/she masturbate ?

Mixed patterns (Reciprocal patterns – eg, vaginismus/premature ejaculation)
Pain
Vulvovestibulitis
Vaginismus
Deep dyspareunia
Paraphilias [5%]

DSM IV “A group of disorders whose essential features are recurrent, intense sexual urges and sexually arousing fantasies generally involving non human objects, suffering, humiliation of one’s self or partner, or children or other non-consenting adults.”

Sexual compulsions

Exhibitionism

Voyeurism

Fetishism

Pedophilia

Sadomasochism

Domination/Submission

Compulsive involvement with pornography (Internet)

Sex Therapy

Mixed messages in the culture

Apparent openness in the media

Few models for adult to adult discussion about sexual issues

Current of prohibition and sex negative values persist

Sex education in the school under siege

Medical schools provide very little

The Sexual Dysfunctions

Large numbers (Recent survey indicates 40%)

People often believe that they are the only failures

Enter a conspiracy of silence

Almost always around as an issue – jokes, movies

Sense of shame/blame/inadequacy

(The relief in the therapist clarifying it )

To whom do they go — MDs are often more uncomfortable

Arousal disorders [10%]

Men

Erectile difficulties in men

Cycle of performance anxiety

Increased awareness of physical components

Women

Inability to maintain adequate vaginal lubrication

Intercourse painful or uncomfortable

May choose to keep problem hidden from partner

Performance anxiety often not considered in women

Etiology

Psychogenic

Medications

Depression

Vascular disease

Hormonal

Neurologic

Orgasm disorders

Men

25% of men struggle with premature ejaculation

Medication may be helpful (SSRIs/Clomipramine)

Squeeze technique