Problems in the male partner after childbirth may have a significant influence on the quality of the couple’s sexual relationship. These problems may be caused by many different factors, some of which will not be fully conscious. A study of the doctor/ patient relationship may provide a clue to the problem. Sometimes the couple are unable to express their feelings openly because of anger or fear of hurting each other. For the family planning doctor the problems may be expressed as difficulties with contraception, or the disturbed sexual relationship may make contraceptive decisions difficult. Where problems in the male partner are acknowledged or suspected, an offer to see him or the couple together can be helpful.

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The rhythm method implies a great deal of control but is poorly understood by many men. Several of those spoken to thought the rhythm method meant withdrawal. Once clarified, it was clear that there were many misunderstandings. The days after menstruation were regarded as safer than those before. However, those couples who did use it seemed to share their understandings and were happy. As expected, these were couples with a keen desire for the natural, or strong religious beliefs. They were aware of confusing medical advice on timings, and had their own feelings about what was safe despite the advice. Usually both the man and the woman knew when she ovulated, and this closeness was apparent in discussion. ‘It puts a brake on us’, said one man. ‘If we have been cross with each other, she doesn’t always ovulate, and then we have to wait.’

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Contraception is often considered to be just about stopping babies, but it also says a great deal about having a good sex life without the fear of a pregnancy. Why are doctors so afraid to bring up the topic of sex with their patients when discussing contraception? It is so important to elicit possible problems early on. Is she wanting a good sex life with no babies? Is she wanting to delay her family until the ‘right time’, and also have a good sex life? Is she wanting to enjoy an active sex life with her partner without the obvious responsibilities that a baby will produce, at the present time or maybe forever? Is she having a sex life at all – or is it just that everyone else takes the Pill when they are in a stable relationship, engaged or getting married? The assumption that sexual intercourse has taken place when the woman has been on the Pill for many years is common, but it is not always justified, and appropriate comments or questions to clarify the situation should be mandatory.

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The provision of the best possible care for young people in today’s society, with pressure towards sexuality coming not just from the internal forces towards maturity which have always been present, but also from the peer group and, most strongly, from the media, is not easy for the professional. There is an over-riding need to provide the practical help necesssary to reduce the risks in an atmosphere that is acceptable to the patient, as has been described in this chapter. Considerable skill is needed to allow the patient to feel that her sexuality is allowable and valuable, while at the same time warning her of the health risks.

What, then, of the more general health education that is offered to other patients? The family planning consultation is seen as an ideal opportunity to broach such subjects as smoking and obesity, but the young person may feel such advice to be ‘yet another lecture’. If given unthinkingly, she or he may be antagonized so that they stop coming for the contraceptive help which is so desperately needed. However, if given sensitively and at an appropriate time, the assumption that she or he is now grown up enough to want to look after themselves can enhance self-esteem.

Perhaps the most difficult dilemma for the doctor, as for young people themselves in the age of AIDS, is to reconcile the strong, inevitable and healthy emotional and sexual drives, with the possible risk of serious damage to their health or even death. The equation

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‘I want a health check,’ she commanded, forceful and unsmiling. Doctors and nurses are not used to being ordered about in this way; it is easy for hackles to rise and defences to spring up. The doctor felt attacked and was tempted to retaliate, to point out that this was family planning, not a well woman clinic, for example. Instead, she inwardly observed this difficult atmosphere, and wondered what was behind it. ‘We haven’t seen you for some time,’ she commented. Mrs A. shrugged, but remained silent. ‘Are you still on the Pill?’ ‘No,’ another shrug, then defiantly, ‘We use a sheath.’ The tension level in the room rose. ‘Look, I’ve come for a health check – that’s all!’ The doctor thought to herself, ‘Contraception produces tension, but is not to be discussed.’ She changed tack. ‘Of course we will examine you. Have you been having any problems?’ Immediately, the reply shot back, ‘No.’ Another glare at the watch. The doctor sat back and waited, refusing to be bounced into this checkup, realizing that, so far, she had been doing the work here. Now she let the patient decide how to continue.

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Because the structure of your mouth and jawbone changes as you age, if you wear a partial or full denture, you should expect the fit of the denture to change as well. In fact, because of the loss of teeth, the jawbone, which supports the dental appliance, will shrink even more quickly than if your own teeth were intact.

Your lower jawbone is especially at risk if you wear a full or partial lower denture, since the base plate of the denture places an abnormal amount of stress on the natural gums and underlying bone. This can cause the jaw to deteriorate even more. As the bone changes, you’ll probably find that you have to change the dentures to fit better. Fortunately, new technology is making possible dentures that fit better and adjust to changes in pressure. They’re also better able to absorb the shock of chewing and biting down, thus redirecting some of the stress away from the gums.

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As with any viral infection, the most severe period is the initial flare-up. When your physician determines that your rash is Ramsay Hunt syndrome, he will treat it with corticosteroidal preparations in either oral or topical form. But because the virus hides in the nerves of the spine for many years, it may cause permanent nerve damage when it surfaces after being dormant for decades. Though this is rare, you should see a neurologist at the first sign of a flare-up.

Special Mention for the Elderly

When an elderly person is affected with Ramsay Hunt syndrome, an extremely painful condition called postherpetic neuralgia can sometimes occur. Men and women 60 years and older are prone to postherpetic neuralgia because of their naturally lower immune systems. Postherpetic neuralgia is signified by facial paralysis, constant headache, and severe pain where the rash initially occurred.

Medications such as Zovirax and pain medications will help lessen the outbreak. If pain persists, a medication such as Zostrix can be very helpful in alleviating it.

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For most of us, a certain amount of deterioration in our vision is almost inevitable as we grow older. I find I can no longer work on models with small parts, as I have trouble focusing my eyes. I refuse to give in, however, which runs counter to the advice that my own ophthalmologist has given me. I will not wear reading glasses or bifocals, mostly for reasons of vanity. Instead, I wear contacts. The lens in one eye is for distance, while the other lens helps me to do close-up work.

I’ve found that what is almost universal among midlife adults and older is the gradual appearance of a kind of farsightedness called presbyopia, in which you will find it increasingly necessary to hold a book or newspaper farther away from you in order to see clearly. Whether you’ve traditionally been nearsighted or farsighted in the past doesn’t matter. And if you’ve always been envious of a friend who’s enjoyed 20/20 vision most of his life, relax, because there is such a thing as divine retribution—even people blessed with perfect vision are affected by presbyopia to some degree.

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Flashing lights are pretty when they’re part of a Christmas or Fourth of July display, but when they regularly occur as part of the early stages of a migraine headache, they quickly lose their luster.

Migraines have the reputation of being able to totally disable a person, and for good reason. If you’ve ever experienced a migraine, also known as a vascular headache, you know that the pain in your head can be so intense that you’re physically unable to do more than lie in bed in a darkened room and wait for the pain to subside.

Before a migraine hits fully, the flashing lights appear because the constricted arteries reduce the flow of blood to the part of the brain that controls your vision. In addition to the flashing lights, you may experience blind spots, vertigo, and nausea. These are all signs that a migraine is imminent.

We don’t know exactly what causes a migraine headache. However, at a migraine’s worst, the carotid and vertebral arteries in the brain, which supply it with blood, first narrow and then swell up, sometimes to twice their normal size. This decreases the amount of blood supplied to your brain. The combination of the swollen arteries and the reduced blood supply is the reason for the crushing pain that can totally incapacitate you. Most migraines last from a few hours to several days. After the pain subsides, you’ll probably feel groggy and lethargic for a while.

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If you think you have temporal arteritis, you should see your doctor immediately, especially if you have experienced sudden blindness. He will conduct a blood test that includes a test for the erythrocyte sedimentation rate, or ESR, which will check how quickly red blood cells settle in the bottom of a test tube. A high ESR is an indication of an inflamed artery, as in temporal arteritis. Your doctor may also perform a biopsy of the temporal artery in order to make a positive diagnosis.

If you do have temporal arteritis, you will need to treat it with a regimen of corticosteroid medication such as prednisone on a long-term basis, possibly for months. This will help reduce the swollen artery to its normal size. In order to prevent future problems, however, you will need to continue taking the medication for a year or more; regular blood tests that monitor the ESR in addition to your symptoms will help your doctor to guide your treatment.

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