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Thursday, February 21, 2008


بطاطا ، البطاطا Potato









الاجزاء المستعملة في البطاطا :الثمرة التي تكمن تحت الارض وهي الجذر .الموطن و التاريخ :اميركا الجنوبية وفي البيرو تحديداً . اصبحت هذه الثمرة الاكثر انتشاراً و استعمالاً في العالم كله ، ويعتمد الغربيون على البطاطا في طعامهم كشريك لجميع اصناف الطعام و خصوصاً انواع الطبخ المحضرة باللحوم بجميع انواعها الحمراء او البيضاء ، ولا يستغني المطبخ الامريكي او الاوروبي عن البطاطا مع الطعام سواء اكانت البطاطا مقلية ام مسلوقة .يفضل طبخ البطاطا بقشرها عن طريق البخار او السلق او الفرن ، لأن الطبقة التي تلي القشرة غنية بالفيتامين ( ج ) و الاملاح . و التقشير يفقد هذه الطبقة قيمتها الغذائية .تركيبتها :• ماء 75%• نشاء 20%• بروتين 2%• مواد شبه زلالية 2%• املاح معدنية 1% • تحتوي ايضاً على الكالسيوم ، الحديد ، البوتاسيوم ، فيتامينات ( ج ، ب ، أ ) بنسبة ضئيلة .يجب إزالة أجزاء البطاطا الخضراء اللون و الرشيمات التي تنبت جديداً من سطح البطاطا لأنها سامة لاحتوائها على مواد Solanine .استعمالات و فوائد البطاطا الطبية :1. غذاء جيد يمكن الاعتماد عليه عند حصول القروح في الجهاز الهضمي أكان ذلك في الامعاء او المعدة ، ويمكن استعمال البطاطا المطبوخ سلقاً لذلك ، اوعصير البطاطا الذي يمتص حموضة أسيد المعدة هيدروكلوريك و يرسب طبقة من نشاء البطاطا على القروح فتحميها من الاسيد و الجراثيم المسماة Helicobacter .2. مدر للبول يفتت الحصى و الرمل .3. ملطف للامراض التي تحل بالامعاء الغليظة و القولون و المسماة حالياً Irritable bowel syndrome .تعمل على تهدئة ثوران المصران الغليظ .4. تهدئ الاعصاب بما تحتويه من فيتامين B complex .5. توضع على الوجه و الجسم في معالجة البثور الملتهبة .6. عصيرها يعالج حروق الجلد و ضربة الشمس ، ويتم ترطيب الجسم عدة مرات يومياً .7. يزيل المغص و النفخة في البطن ، عبر إطلاق الارياح .

فوائد الثوم




الثوم يرفع الكفاءة الجنسية ويطيل العمر









عدّه القدماء ترياقاً يشفي من جميع الأمراض ونسبت إليه صفتان جوهريتان: فهو مقوي فعال، ألم يكن يوزع على العمال الذين بنوا أهرام الجيزة وهي واحدة من السبع العجائب لمنحهم القوة؟! وهو كذلك واقٍ من الطاعون.
وقد ذكرت التوراة أن بوذا كان يقدم الثوم لعمال الحصاد ليمنحهم القوة والمناعة ضد الأوبئة، وينسب التلمود إلى الثوم القدرة على قتل الديدان المعوية، وزيادة غزارة المني.
أما الطب الحديث فإنه يعترف للثوم بقدرته على تخفيف ضغط الدم بفضل أثره في الشرايين الصغيرة وقابلية تقلص القلب وتنشيطه، ويسهل دوران الدم وينقيه وتستخدم مستخرجاته على نطاق واسع في إعداد الأدوية الحديثة المضادة للتوتر.
أما خصائصه المطهرة والقاضية على الجراثيم والمتخمة التي ذكرها الرومان ومدرسة (سالرن) فقد جعلته فعالاً لا في مكافحة الأمراض المعدية فحسب، بل في الشفاء من التهاب الشعب والزكام والعدوى التنفسية الموسمية.
ويؤثر الثوم في أعضاء الهضم، باعتباره مطهراً، ويكافح الإسهال، ويؤسف لأن المعدة الحساسة لا تتحمله.
والثوم كذلك ممتاز في القضاء على الديدان فهو يؤثر في التخلص من الأسكاريس والأقصور.
أما خصائصه المثيرة لاحمرار الجلد وبثوره فتجعله مفتتاً للثفن، وهناك قصة تروى عن الطاعون الذي اجتاح مدينة مارسيليا سنة 1776م والذي فتك بعشرات الآلاف من أهلها، إذ قيل أن أربعة من اللصوص قبض عليهم وهم ينهبون أسواق المدينة المنكوبة دونما خوف من الإصابة بالطاعون وحكم عليهم بالإعدام مع وعد بإعفائهم من العقوبة إذا ما كشفوا عن السر الذي جعلهم يتقون العدوى بالطاعون، وهنا كشف اللصوص الأربعة الستار عن أنهم كانوا قد تناولوا دواءً سحرياً مؤلفاً من الثوم والخل، فكان ذلك سبباً في ظهور وصفة (الخل المعقم بالثوم) ضد الجروح والأنتان.
إن غنى الثوم بالفوسفور والكلس يجعل منه منشطاً للجسم وسبباً في إطالة العمر، كما أن مضغه بشكل جيد واختلاطه باللعاب يجعل منه محرضاً ممتازاً للشهية إذ يحرك جدران المعدة وينبه العصارة المعدية فيكافح التخمة بمجرد تناول حساء صنع منه.
ولقد كانت القدرة الفائقة للثوم على قتل الجراثيم مدار بحث العلماء في مختلف العصور فقد كانوا يريدون معرفة المادة التي تمنحه تلك القدرة، إلى أن كان عام 1944 عندما استطاع العلماء عزل مادة (الآليسين) وهي المادة الأساسية التي تكمن وراء الصفات العلاجية النادرة والرائحة الخاصة التي يتميز الثوم بها. ونظراً لوجود الزيوت الطيارة في الثوم فإنه يساعد الرئتين على التنفس وخاصة في الحالات المرضية كالبرونشيت والربو والسعال الديكي.
وقد تبين أن الثوم واق فعال من تصلب الشرايين لأنه يحول دون وجود الكوليسترول على جدار الشرايين، وينقي الدم من الكوليسترول والمواد الدهنية ويفتل الجراثيم التي تسبب الدفتريا والسل وفي بعض الحالات يكون أشد فعالية من البنسلين وبعض المضادات الحيوية.
يوجد في الثوم سكر سكوروبوز وهو سكر رباعي يتكون من أربع وحدات م.فركتوز كما يوجد به مركبات عضوية كبريتية مثل ثنائي كبريتيد الآيل بروبايل وثنائي كبريتيد ثنائي الآيل كما يوجد فيه الآليسين وهو مضاد البكتيريا الرئيسي.
ولدى التحليل تبين أنه يحتوي على 25% من زيت طيار فيه مركبات كبريتية كما يحتوي على 49% بروتين و0.2 دهن و22 فحمائيات و0.47% أملاح و60% ماء.
ويؤكد العلماء أن أفضل أنواع الأدوية الخاصة بأمراض القلب هي التي يدخل فيها الثوم بشكل أو بآخر كعنصر أساسي، وهو معالج ممتاز لحالات الربو وتلوث الفم والأسنان والجهاز البولي وضعف الأعصاب والصداع والزكام والرشح والأنفلونزا وآلام الأذن والإسهال الديزنطاري وفي تقوية الشعر والقضاء على القشرة ولاحتوائه على مادة الألبين فهو مكافح جيد للسرطان وينفع في ضغط الدم المرتفع والوقاية من التيفوس والروماتيزم ويساعد في معالجة ضعف الانتصاب لدى الرجال ويرفع الكفاءة الجنسية، ويقي من الإيدز والأوبئة.
لقد ورد في أحاديث النبي (صلى الله عليه وآله) وأهل بيته الأطهار (عليهم السلام) عظيم ذكر للثوم فعن الإمام علي (عليه السلام) قال: قال رسول الله (صلى الله عليه وآله): كلوا الثوم وتداووا به فإن فيه شفاء من سبعين داء.
وفي الرسالة الذهبية للإمام الرضا (عليه السلام): ومن أراد أن لا يصيبه ريح في بدنه، فليأكل الثوم كل سبعة أيام.
وعن أمير المؤمنين (عليه السلام) قال: لا يصح أكل الثوم إلا مطبوخاً.

عشر حقائق بشأن الأدوية الأساسية

مفكرة الإسلام: نشرت منظمة الصحة العالمية مؤخرًا تقريرًا يتضمن عشر حقائق بشأن الأدوية الأساسية, وقائمة الأدوية الأساسية هي جرد للأدوية التي تعالج أكثر المشكلات الصحية إلحاحًا في العالم. ويتم تحديد تلك الأدوية من خلال عملية مسندة بالبيّنات، كما أنّ الجودة ومعدلات الأمان والكفاءة والفاعلية تمثّل المعايير الأساسية لاختيار تلك الأدوية. وتعطي القائمة النموذجية - التي تم تشكيلها من قبل أحد فرق الخبراء التابعة لمنظمة الصحة العالمية في عام 1977 ويجري تنقيحها الآن مرّة كل سنتين لبلورة المشكلات الصحية الراهنة - للبلدان الأعضاء في المنظمة مثالاً يمكنها الاقتداء به للتكيّف مع الاحتياجات الوطنية.

ويُحتفل هذا العام بمرور 30 عامًا على وضع قائمة منظمة الصحة العالمية النموذجية للأدوية الأساسية. ففي عام 1977 مكّنت أوّل قائمة من تحديد 208 أدوية أساسية لمكافحة عبء الأمراض على الصعيد العالمي السائد في ذلك الوقت. أمّا القائمة الحالية فتشمل 340 دواءً منها أدوية تعالج الأمراض ذات الأولوية، مثل الملاريا والإيدز والعدوى بفيروسه والسل ومشاكل الصحة الإنجابية، وأدوية أخرى تمكّن ـ بشكل متزايد ـ من معالجة أمراض مزمنة مثل السرطان والسكري.

وقد تم إحراز تقدم كبير في هذا المجال طيلة السنوات الثلاثين الماضية: فهناك، حاليًا، قوائم رسمية بالأدوية الأساسية لدى 156 دولة من أصل مجموع الدول الأعضاء في منظمة الصحة العالمية والبالغ عددها 193 دولة.

وقد جاء في التقرير الحقائق التالية:

أولاً: هناك عدة عوامل تعرقل توافر الأدوية في البلدان النامية, منها ما يلي:

• نقص الإمدادات الدوائية ونُظم التوزيع.

• عدم كفاية المرافق الصحية والعاملين الصحيين.

• نقص الاستثمار في الصحة وارتفاع تكاليف الأدوية.

ويمكن أن تساعد قائمة الأدوية الأساسية البلدان على ترشيد شراء الأدوية وتوزيعها، والحد بالتالي من التكاليف التي يتحمّلها النظام الصحي.

ثانيًا: تشكّل المستحضرات الصيدلانية 15% إلى 30% من مجموع النفقات الصحية في البلدان التي تمرّ اقتصاداتها بمرحلة انتقالية, و25% إلى 66% من تلك النفقات في البلدان النامية. وتمثّل الأدوية، في بعض البلدان النامية، أكبر المصروفات الصحية بالنسبة للأسر الفقيرة.

ثالثًا: أظهرت إحدى الدراسات الاستقصائية التي أجرتها منظمة الصحة العالمية في الصين في عام 2006 على 41 دواءً - منها 19 دواءً أساسيًا - أنّ 10% فقط من تلك الأدوية كانت متاحة في الصيدليات كمنتجات ذات علامات تجارية و15% كانت متاحة كمنتجات جنيسة.

رابعًا: أظهرت إحدى الدراسات الاستقصائية التي أُجريت في أوغندا في عام 2004 أنّه لا يمكن العثور في المرافق الصحية المجانية إلاّ على 55% من مجموع الأدوية الأساسية الواردة في القائمة الوطنية والبالغ عددها 28 دواءً. وكانت المبالغ "التي يدفعها المريض من جيبه" لاقتناء الأدوية أعلى من الأسعار المرجعية الدولية بنحو 13.6 مرّة, فيما يخص المنتجات ذات العلامات التجارية وبنحو 2.6 مرّة فيما يخص الأدوية الجنيسة.

خامسًا: لم يكن عدد البلدان التي كانت تملك قائمة بالأدوية الأساسية في عام 1977 يتجاوز 12 بلدًا. أمّا اليوم فقد اعتمدت أربعة أخماس البلدان قوائم دوائية وطنية. وينبغي، كي تُختار الأدوية لإدراجها في القائمة، أن تكون متوافرة عن طريق النُظم الصحية, وذلك بالكميات والجرعات المناسبة. وتُعد قائمة الأدوية الأساسية حجر الزاوية بالنسبة للسياسات الدوائية الوطنية والنظام الصيدلاني قاطبة.

سادسًا: يمكن، بحلول عام 2015، توقي أكثر من 10 ملايين من الوفيات كل عام بتعزيز بعض التدخلات الصحية المعيّنة، التي تعتمد غالبيتها على الأدوية الأساسية. وكان إعلان ألما - آتا الصادر في عام 1978 - الذي يُعد أحد المعالم الكبرى في مجال الصحة العمومية الدولية - أوّل وثيقة رسمية تؤكّد أهمية الرعاية الصحية الأوّلية والدور الذي تؤديه الأدوية الأساسية على الصعيد العالمي.

سابعًا: لم تكن معظم البلدان تدرك مفهوم السياسة الدوائية الوطنية قبل 30 عامًا. أمّا اليوم فهناك أكثر من 100 بلد ممّن تملك سياسات دوائية قائمة أو قيد التصميم. ويمكن أن تشكّل تلك السياسات الأُطر التي تمكّن من المضي قدمًا بالإصلاحات اللازمة في القطاع الصيدلاني. ومن البلدان الرائدة في مجال الأدوية الأساسية موزمبيق وبيرو وسري لانكا.

ثامنًا: لقد كانت المعلومات الموضوعية بشأن الاستخدام العقلاني للأدوية محدودة جدًا، وبخاصة في البلدان النامية. أمّا اليوم فهناك ما لا يقلّ عن 135 من البلدان التي تملك أدلتها واستماراتها الخاصة التي تحتوي على معلومات حديثة ودقيقة وغير متحيّزة.

تاسعًا: هناك شبكة عالمية انبثقت وتطوّرت بجهد دولي بدأ في عام 1977 وهي تضمّ الآن 83 بلدًا وتعمل على رصد التفاعلات الدوائية الضارة ومشاكل الأمان المحتملة.

عاشرًا: لقد كانت المعلومات عن أسعار الأدوية شبه منعدمة بالنسبة للجمهور قبل ثلاثين عامًا, ولم يكن سوى عدد قليل من البلدان يشجع على إنتاج الأدوية الجنيسة البديلة. أمّا اليوم فهناك 33 من البلدان التي تجمع المعلومات الخاصة بالأسعار وتتيحها للجماهير. وقد مكّن استخدام الأدوية الجنسية من تخفيض الأسعار بفضل زيادة الطلب والتنافس

أدوية الضعف الجنسي ( فياغرا ) من النواحي النفسية

<مما لاشك فيه أن اضطرابات الوظيفة الجنسية هي من الاضطرابات الشائعة في جميع المجتمعات ..ويساهم الطب النفسي مع عدد من فروع الطب الأخرى مثل الجراحة التناسلية وطب الأمراض النسائية وطب الأمراض الجلية والتناسلية في ميدان الاضطرابات الجنسية .

وإذا تحدثنا عن الضعف الجنسي عند الذكور نجد أن " هاجس الداء الجنسي والقوة الجنسية " قديم في تاريخ البشرية .. وهناك عشرات من الطرق المتنوعة التي فكر فيها الإنسان وابتكرها لتحسن أدائه الجنسي وتأكيد قوته ..ومنها تناول أعشاب خاصة أو طعام معين أو القيام بأشكال من الطقوس والرقصات واستعمال جلود بعض الحيوانات أو أجزاء منها ، وغير ذلك كثير وغريب ..

وفي الطب الحديث هناك عدد من العمليات الحراحية التي تساهم بإعادة الوظيفة الجنسية المضطربة إلى طبيعتها ، أو تساعدها في ذلك . كما أن هناك عدد من الأدوية المتنوعة والتي تختلف في فعاليتها وكيفية استخدامها والحالات التي توصف لها .

والدواء الأخير ( فياغرا ) الذي تم تصنيعه وتسويقه مؤخراً ، يعتبر كشفاً علمياً هاماً ويمكن أن يساعد كثيراً من المرضى . والمعلومات الحالية عنه تفيد بأنه دواء فعال ومفيد وآثاره الجانبية قليلة عموماً . ويجب أن يوصف بإشراف الطبيب لأنه يتعارض مع بعض الأدوية القلبية وأدوية أخرى . وله جرعات محددة وهي 50 ملغ تؤخذ قبل حوالي ساعة من المناسبة الجنسية ولمرة واحدة على الأكثر في اليوم .( وفي بعض الحالات تستعمل عيارات أقل أو أكثر بإشراف الطبيب )

وهو يفيد في حالات صعوبة الانتصاب الناتجة عن إصابات النخاع الشوكي والاكتئاب وارتفاع ضغط الدم والسكري وغير ذلك . وتتفاوت نسبة الاستجابة للدواء من حالة لأخرى وفقاً للتشخيص ونوعية الاضطراب .

وهذا الدواء وافقت عليه هيئة الدواء الأمريكية بعد إجراء التجارب والدراسات العلمية الضرورية من حيث الفعالية والأمان والآثار الجانبية وغير ذلك .

ويبدو أن استعمال الدواء قد تجاوز المعايير الطبية المعروفة ، مما أدى إلى مخاطر ومشكلات طبية واجتماعية وشائعات متنوعة ..

والنظرة الطبية تؤكد على " حسن استعمال الدواء " وليس سوء الاستعمال ..وذلك بالنسبة لجميع الأدوية بما فيها الأدوية الجنسية . وأيضاً لابد من التريث في إطلاق الأحكام على أي دواء حديث ولو تمت الموافقة عليه ، لأن الاستعمال الواسع للدواء مع مرور الوقت يعطي معلومات هامة عنه ، مما يمكن أن يعدل المعلومات الأولى أو يغيرها . ومن المعروف أن عدداً من الأدوية قد تم سحبها وإنهاء الموافقة عليها بعد فترة من استعمالها في مختلف المجالات الطبية . وهكذا حال الطب والعلم التجريبي لأنه في أحسن أحواله نسبي وليس فيه حقائق مطلقة ونهائية .

ومن النواحي النفسية لابد من التأكيد على أهمية العوامل النفسية في نشوء الاضطرابات الجنسية عند الذكور وعند الإناث .. والإحصائيات القديمة تبين أن 90 بالمئة من صعوبات الانتصاب سببها نفسي ، والدراسات الحديثة تؤكد أن نسبتها حوالي 50 - 65 بالمئة .

والأسباب النفسية عديدة .. ومنها المشكلات الزوجية ، والقلق ، والاكتئاب ، والعقد الجنسية ، والخوف من الفشل ، والشعور بالذنب ، إضافة لضعف الثقة بالنفس ، والتجارب الجنسية الخاطئة ، وغير ذلك .

ويعتمد العلاج الجنسي على تبديد المخاوف وتعديلها ، وتصحيح المعلومات الخاطئة حول الأمور الجنسية ، وعلى إزالة الحساسية السلبية المرتبطة بالأداء الجنسي ، وعلى عدد من التدريبات المشتركة مع الشريك الزوجي بهدف إعادة الثقة والأمان بينهما ، وإعادة الاستجابة الطبيعية .

كما أن العلاج الأسري والفردي يساهم في تخلص الفرد من عقده الخاصة وقلقه الجنسي ، ويساهم في تشجيع التعامل الإيجابي والسلوك الناضج والمتوازن مع زوجه ، مما يضمن تحسن الاضطراب الجنسي وتحسن العلاقة الزوجية أيضاً .

ويستفاد في الطب الجنسي النفسي من أساليب أخرى .. ومنها بعض الأدوية . ودواء " فياغرا " يمكن الاستفادة منه في النواحي النفسية إذا استعمل بشكل مؤقت حيث يساهم " تحسن الأداء " في تعديل نظرة المريض عن نفسه ، وفي تشجيعه على التخلص من عقده وقلقه وغير ذلك

ولابد من التأكيد أن الإنسان " جسم وعقل وروح " وهو " كائن اجتماعي " يمارس وظائفه الطبيعية ضمن المجتمع البشري . وتأكيد مادية الإنسان والنظر إليه على أنه مجموعة من الأعضاء المتصلة .. يعني نظرة ضيقة وخيالية لا يمكنها مهما بلغت في دقتها أن تقدم الأجوبة الشافية والشاملة لمشكلات البشر الطبية والجنسية .. والإفراط في تطبيق الأمور المادية يحول الإنسان إلى شيء أو " آلة متحركة أو غير متحركة " .. وفي ذلك ظلم له وانحراف في النظر إليه .

وفي النهاية لابد من التأكيد على أن الطب الحديث يمكن أن يقدم فوائد عديدة للإنسان . ومن المتوقع أن يزداد الاهتمام بالمشكلات الجنسية وعلاجاتها .. وبعض العلاجات لا تقدم كثيراً ، وبعضها أنجح من بعض .

ولابد من النظر للوظيفة الجنسية ضمن إطارها الصحيح المتكامل من النواحي العضوية والنفسية والاجتماعية .. وإلا فإن الفشل والإحباط والمشكلات الإضافية هو المتوقع ..

ولا يمكن أن تصلح حبة دواء تركيبة الإنسان النفسية ، أو مشكلته الزوجية ، إلا في الخيال أو التفكير السحري غير الواقعي .

ومن المتوقع ازدياد سوء استعمال الأدوية التي تعالج اضطراب الوظيفة الجنسية من قبل أشخاص ليسوا بحاجة إليها . وذلك لأن وجود دواء يؤثر على الوظيفة الجنسية يداعب خيالات البحث عن القوة والمتعة الكاملة ، وهي خيالات ذات أساس طفولي ومراهق ولكنها عميقة ولها جوانب لاشعورية . وتأتي الدعاية والشائعات والأفكار السطحية المتداولة لتزيد من هذه الدوافع وتثبت أخطاءها وعدم واقعيتها .. مما يمكن أن يؤدي إلى مشكلات جديدة قد تكون خطيرة .. إضافة إلى القلق والإحباط ، وأيضاً إلى الاضطراب الجنسي

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Biotherm - Hair Care

Monday, February 18, 2008



Hair Re. Source Nutri-Repair Conditioning Cream for Dry & Damaged Hair 200ml/6.76oz

Hair Re. Source Nutri-Repair Conditioning Cream for Dry & Damaged Hair

Biotherm - Hair Care



Hair Re. Source Nourishing Shampoo for Dry and Damaged Hair 250ml/8.45oz

Enriched with minerals & essential oils of rosemary & lavender

Incredibly replenishes moisture to dry, damaged hair

Embraces hair with delicious fruity aroma

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Suitable for normal to dry hair

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Hair Re. Source Bounce & Shine Conditioning Lotion for Normal Hair 150ml/5.07oz

Hair Re. Source Bounce & Shine Conditioning Lotion for Normal Hair

Biotherm - Sunfitness - Body Care



Sunfitness After Sun Soothing Rehydrating Milk 400ml/13.52oz

Effectively comforts the skin after sun exposure

Enriched with Pure Extract of Thermal Plankton & glycerol

Provides high moisture level to keep a long lasting, even tan

Remarkably revitalizes & energizes skin with anti-aging properties

Speeds up the skin renewal process & enhances its defense system

Leaves skin stay soft, firm, young & beautiful

Biotherm - Age Fitness Power 2 - Night Care



Biotherm
Age Fitness Power 2 Recharging & Renewing Night Treatment ( Dry Skin ) 50ml/1.69oz

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To use: Apply over the cleansed face & neck in evening. Avoid eye contour area

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Sun Refreshing Oil SPF 6 150ml/5oz

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Biotherm - Acnopur - Cleanser


Acnopur Clarifying Exfoliating Lotion ( Oil-Free ) 200ml/6.7oz

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To use: Apply to entire body after shower

HEPATITIS B

Thursday, February 7, 2008

Hepatitis B is a serious liver disease caused by a virus which is called hepatitis B virus (HBV).


One out of 20 people in the United States have been infected with HBV some time during their lives. In 2004, an estimated 60,000 people were infected with HBV. People of all ages get hepatitis B and about 5,000 die each year from sickness caused by HBV.


HBV is spread by having sex with an infected person. You are at risk of HBV infection by sexual contact if you:

are a sex partner of someone who is infected with HBV
are sexually-active and are not in a long-term, mutually monogamous relationship (e.g., you have had more than one sex partner in the previous 6 months)
have other STDs
are a man having sex with a man
HBV is spread by exposure to infected blood from skin puncture or contact with mucous membranes. You are at risk of HBV infection from these exposures if you:

live in the same house with someone who is infected with HBV and share personal items such as toothbrushes, razors, etc…
shoot drugs
have a job that involves contact with human blood or body fluids
have end stage kidney disease
HBV is spread from an infected mother to her infant during birth.

HBV is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, coughing, sneezing, or casual contact.


Sometimes a person with HBV infection has no symptoms at all. Older people are more likely to have symptoms. You might be infected with HBV (and be spreading the virus) and not know it.

If you have symptoms, they might include yellow skin or yellowing of the whites of your eyes (jaundice); tiredness; loss of appetite; nausea; abdominal discomfort; dark urine; grey-colored bowel movements; or joint pain.


Some people who become infected with HBV develop chronic (lifelong) infection.
Chronic infection increases the risk for cirrhosis (scarring of the liver), liver cancer, and liver failure. About 15%-25% of people with chronic HBV infection might die prematurely from liver cirrhosis or liver cancer.


HBV can be spread from an infected mother to her infant during birth. To prevent spread of HBV from infected mothers to their infants, every woman should have her blood tested for hepatitis B surface antigen (HBsAg) during each pregnancy.

Infants born to infected mothers need to get hepatitis B vaccine and another shot call HBIG (hepatitis B immune globulin) soon after birth to prevent infection.


A blood test is the only way to diagnose hepatitis B.


There are no medications available for recently acquired (acute) HBV infection. There are antiviral drugs available for the treatment of chronic HBV infection.


Hepatitis B vaccine is the best prevention against hepatitis B. Hepatitis B vaccine is recommended for all infants, for children and adolescents who were not vaccinated as infants, and for all unvaccinated adults who are at risk for HBV infection as well as any adult who wants to be protected against HBV infection.

The surest way to avoid transmission of all sexually transmitted diseases is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Latex condoms, when used consistently and correctly, may reduce the risk of HBV transmission.

Never inject illegal drugs. If you are currently using, stop or get into a treatment program; if you can't stop, never share needles, syringes, water, or "works.”

Syphilis INFECTION

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases.



In the United States, health officials reported over 32,000 cases of syphilis in 2002, including 6,862 cases of primary and secondary (P&S) syphilis. In 2002, half of all P&S syphilis cases were reported from 16 counties and 1 city; and most P&S syphilis cases occurred in persons 20 to 39 years of age. The incidence of infectious syphilis was highest in women 20 to 24 years of age and in men 35 to 39 years of age. Reported cases of congenital syphilis in newborns decreased from 2001 to 2002, with 492 new cases reported in 2001 compared to 412 cases in 2002.

Between 2001 and 2002, the number of reported P & S syphilis cases increased 12.4 percent. Rates in women continued to decrease, and overall, the rate in men was 3.5 times that in women. This, in conjunction with reports of syphilis outbreaks in men who have sex with men (MSM), suggests that rates of syphilis in MSM are increasing.



Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.



Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. Although transmission appears to occur from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, most transmission is from persons who are unaware of their infection.

Primary Stage
The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.

Secondary Stage
Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and late stages of disease.

Late Stage
The latent (hidden) stage of syphilis begins when secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. In the late stages of syphilis, it may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This internal damage may show up many years later. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.



The syphilis bacterium can infect the baby of a woman during her pregnancy. Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby born dead) or of giving birth to a baby who dies shortly after birth. An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may become developmentally delayed, have seizures, or die.



Some health care providers can diagnose syphilis by examining material from a chancre (infectious sore) using a special microscope called a dark-field microscope. If syphilis bacteria are present in the sore, they will show up when observed through the microscope.

A blood test is another way to determine whether someone has syphilis. Shortly after infection occurs, the body produces syphilis antibodies that can be detected by an accurate, safe, and inexpensive blood test. A low level of antibodies will stay in the blood for months or years even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.



Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV infection when syphilis is present.

Ulcerative STDs that cause sores, ulcers, or breaks in the skin or mucous membranes, such as syphilis, disrupt barriers that provide protection against infections. The genital ulcers caused by syphilis can bleed easily, and when they come into contact with oral and rectal mucosa during sex, increase the infectiousness of and susceptibility to HIV. Having other STDs is also an important predictor for becoming HIV infected because STDs are a marker for behaviors associated with HIV transmission.



Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.

Because effective treatment is available, it is important that persons be screened for syphilis on an on-going basis if their sexual behaviors put them at risk for STDs.

Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.



Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection. Only laboratory tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Talking with a health care provider will help to determine the need to be re-tested for syphilis after treatment has been received.



The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior. It is important that sex partners talk to each other about their HIV status and history of other STDs so that preventive action can be taken.

Genital ulcer diseases, like syphilis, can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of syphilis, as well as genital herpes and chancroid, only when the infected area or site of potential exposure is protected.

Condoms lubricated with spermicides (especially Nonoxynol-9 or N-9) are no more effective than other lubricated condoms in protecting against the transmission of STDs. Based on findings from several research studies, N-9 may itself cause genital lesions, providing a point of entry for HIV and other STDs. In June 2001, the CDC recommended that N-9 not be used as a microbicide or lubricant during anal intercourse. Transmission of a STD, including syphilis cannot be prevented by washing the genitals, urinating, and or douching after sex. Any unusual discharge, sore, or rash, particularly in the groin area, should be a signal to refrain from having sex and to see a doctor immediately

HIV INFECTION

How is HIV Transmitted ?

HIV is spread by sexual contact with an infected person, by sharing needles and/or syringes (primarily for drug injection) with someone who is infected, or, less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors. Babies born to HIV-infected women may become infected before or during birth or through breast-feeding after birth.

In the health care setting, workers have been infected with HIV after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood gets into a worker’s open cut or a mucous membrane (for example, the eyes or inside of the nose). There has been only one instance of patients being infected by a health care worker in the United States; this involved HIV transmission from one infected dentist to six patients. Investigations have been completed involving more than 22,000 patients of 63 HIV-infected physicians, surgeons, and dentists, and no other cases of this type of transmission have been identified in the United States.

Some people fear that HIV might be transmitted in other ways; however, no scientific evidence to support any of these fears has been found. If HIV were being transmitted through other routes (such as through air, water, or insects), the pattern of reported AIDS cases would be much different from what has been observed. For example, if mosquitoes could transmit HIV infection, many more young children and preadolescents would have been diagnosed with AIDS.

All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by state and local health departments with the assistance, guidance, and laboratory support from CDC. No additional routes of transmission have been recorded, despite a national sentinel system designed to detect just such an occurrence.

The following paragraphs specifically address some of the common misperceptions about HIV transmission.

HIV in the Environment, is Environmental Transmission Possible?

Scientists and medical authorities agree that HIV does not survive well in the environment, making the possibility of environmental transmission remote. HIV is found in varying concentrations or amounts in blood, semen, vaginal fluid, breast milk, saliva, and tears. (See page 3, Saliva, Tears, and Sweat.) To obtain data on the survival of HIV, laboratory studies have required the use of artificially high concentrations of laboratory-grown virus. Although these unnatural concentrations of HIV can be kept alive for days or even weeks under precisely controlled and limited laboratory conditions, CDC studies have shown that drying of even these high concentrations of HIV reduces the amount of infectious virus by 90 to 99 percent within several hours. Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, drying of HIV-infected human blood or other body fluids reduces the theoretical risk of environmental transmission to that which has been observed--essentially zero. Incorrect interpretation of conclusions drawn from laboratory studies have unnecessarily alarmed some people.

Results from laboratory studies should not be used to assess specific personal risk of infection because (1) the amount of virus studied is not found in human specimens or elsewhere in nature, and (2) no one has been identified as infected with HIV due to contact with an environmental surface. Additionally, HIV is unable to reproduce outside its living host (unlike many bacteria or fungi, which may do so under suitable conditions), except under laboratory conditions, therefore, it does not spread or maintain infectiousness outside its host.

Can HIV be Transmitted in a Household between Family Members?

Although HIV has been transmitted between family members in a household setting, this type of transmission is very rare. These transmissions are believed to have resulted from contact between skin or mucous membranes and infected blood. To prevent even such rare occurrences, precautions, as described in previously published guidelines, should be taken in all settings "including the home" to prevent exposures to the blood of persons who are HIV infected, at risk for HIV infection, or whose infection and risk status are unknown. For example,

Gloves should be worn during contact with blood or other body fluids that could possibly contain visible blood, such as urine, feces, or vomit.
Cuts, sores, or breaks on both the care giver’s and patients exposed skin should be covered with bandages.
Hands and other parts of the body should be washed immediately after contact with blood or other body fluids, and surfaces soiled with blood should be disinfected appropriately.
Practices that increase the likelihood of blood contact, such as sharing of razors and toothbrushes, should be avoided.
Needles and other sharp instruments should be used only when medically necessary and handled according to recommendations for health-care settings. (Do not put caps back on needles by hand or remove needles from syringes. Dispose of needles in puncture-proof containers
Can HIV be Transmitted in Businesses and Other Settings?

There is no known risk of HIV transmission to co-workers, clients, or consumers from contact in industries such as food-service establishments (see information on survival of HIV in the environment). Food-service workers known to be infected with HIV need not be restricted from work unless they have other infections or illnesses (such as diarrhea or hepatitis A) for which any food-service worker, regardless of HIV infection status, should be restricted. CDC recommends that all food-service workers follow recommended standards and practices of good personal hygiene and food sanitation.

In 1985, CDC issued routine precautions that all personal-service workers (such as hairdressers, barbers, cosmetologists, and massage therapists) should follow, even though there is no evidence of transmission from a personal-service worker to a client or vice versa. Instruments that are intended to penetrate the skin (such as tattooing and acupuncture needles, ear piercing devices) should be used once and disposed of or thoroughly cleaned and sterilized. Instruments not intended to penetrate the skin but which may become contaminated with blood (for example, razors) should be used for only one client and disposed of or thoroughly cleaned and disinfected after each use. Personal-service workers can use the same cleaning procedures that are recommended for health care institutions.

CDC knows of no instances of HIV transmission through tattooing or body piercing, although hepatitis B virus has been transmitted during some of these practices. One case of HIV transmission from acupuncture has been documented. Body piercing (other than ear piercing) is relatively new in the United States, and the medical complications for body piercing appear to be greater than for tattoos. Healing of piercings generally will take weeks, and sometimes even months, and the pierced tissue could conceivably be abraded (torn or cut) or inflamed even after healing. Therefore, a theoretical HIV transmission risk does exist if the unhealed or abraded tissues come into contact with an infected person’s blood or other infectious body fluid. Additionally, HIV could be transmitted if instruments contaminated with blood are not sterilized or disinfected between clients.

Can HIV be Transmitted by Kissing?

Casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV. Because of the potential for contact with blood during "French" or open-mouth kissing, CDC recommends against engaging in this activity with a person known to be infected. However, the risk of acquiring HIV during open-mouth kissing is believed to be very low. CDC has investigated only one case of HIV infection that may be attributed to contact with blood during open-mouth kissing.

Can HIV be Transmitted by Biting?

In 1997, CDC published findings from a state health department investigation of an incident that suggested blood-to-blood transmission of HIV by a human bite. There have been other reports in the medical literature in which HIV appeared to have been transmitted by a bite. Severe trauma with extensive tissue tearing and damage and presence of blood were reported in each of these instances. Biting is not a common way of transmitting HIV. In fact, there are numerous reports of bites that did not result in HIV infection.

Can HIV be Transmitted by Saliva, Tears or Sweat?

HIV has been found in saliva and tears in very low quantities from some AIDS patients. It is important to understand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not been recovered from the sweat of HIV-infected persons. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.

Can Insects Transmit HIV?

From the onset of the HIV epidemic, there has been concern about transmission of the virus by biting and bloodsucking insects. However, studies conducted by researchers at CDC and elsewhere have shown no evidence of HIV transmission through insects--even in areas where there are many cases of AIDS and large populations of insects such as mosquitoes. Lack of such outbreaks, despite intense efforts to detect them, supports the conclusion that HIV is not transmitted by insects.

The results of experiments and observations of insect biting behavior indicate that when an insect bites a person, it does not inject its own or a previously bitten person’s or animal’s blood into the next person bitten. Rather, it injects saliva, which acts as a lubricant or anticoagulant so the insect can feed efficiently. Such diseases as yellow fever and malaria are transmitted through the saliva of specific species of mosquitoes. However, HIV lives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites, HIV does not reproduce (and does not survive) in insects. Thus, even if the virus enters a mosquito or another sucking or biting insect, the insect does not become infected and cannot transmit HIV to the next human it feeds on or bites. HIV is not found in insect feces.

There is also no reason to fear that a biting or bloodsucking insect, such as a mosquito, could transmit HIV from one person to another through HIV-infected blood left on its mouth parts. Two factors serve to explain why this is so--first, infected people do not have constant, high levels of HIV in their bloodstreams and, second, insect mouth parts do not retain large amounts of blood on their surfaces. Further, scientists who study insects have determined that biting insects normally do not travel from one person to the next immediately after ingesting blood. Rather, they fly to a resting place to digest this blood meal.

Are Condoms Effective in Preventing transmission?

Condoms are classified as medical devices and are regulated by the Food and Drug Administration (FDA). Condom manufacturers in the United States test each latex condom for defects, including holes, before it is packaged. The proper and consistent use of latex or polyurethane (a type of plastic) condoms when engaging in sexual intercourse--vaginal, anal, or oral--can greatly reduce a person’s risk of acquiring or transmitting sexually transmitted diseases, including HIV infection.

There are many different types and brands of condoms available--however, only latex or polyurethane condoms provide a highly effective mechanical barrier to HIV. In laboratories, viruses occasionally have been shown to pass through natural membrane ("skin" or lambskin) condoms, which may contain natural pores and are therefore not recommended for disease prevention (they are documented to be effective for contraception). Women may wish to consider using the female condom when a male condom cannot be used.

For condoms to provide maximum protection, they must be used consistently (every time) and correctly. Several studies of correct and consistent condom use clearly show that latex condom breakage rates in this country are less than 2 percent. Even when condoms do break, one study showed that more than half of such breaks occurred prior to ejaculation.

When condoms are used reliably, they have been shown to prevent pregnancy up to 98 percent of the time among couples using them as their only method of contraception. Similarly, numerous studies among sexually active people have demonstrated that a properly used latex condom provides a high degree of protection against a variety of sexually transmitted diseases, including HIV infection

Average Penis Size

What research tells us about average penis size
Determining the average penis size for a group of males, let alone for men around the world, is more complicated than you might imagine. Unfortunately most information about average penis size comes from popular culture and not science. Let's start by considering some figures from science.
The results from three studies of penis size where the measurements were taken in a laboratory setting give the following ranges:
Average penis length (flaccid/not erect): from 3.4 inches to 3.7 inches (8.6 cm to 9.3 cm)
Average penis length (erect): from 5.1 inches to 5.7 inches (12.9 cm to 14.5 cm)
Average penis girth (circumference when erect): from 3.5 inches to 3.9 inches (8.8 cm to 10 cm)
These numbers are obviously very different from the sizes we hear (and see) in adult movies, and even the kinds of numbers you read on line.

Why such a difference?
Many, possibly most, statistics you read are not from legitimate research, but from marketing companies who want you to feel bad about your penis size (so you’ll buy their product).
Important facts about reports of average penis size
There is much greater variation in size of flaccid (non-erect) penises than of penises when they are erect. A soft penis that looks large may be roughly the same size when erect as a soft penis that looks smaller.
Because most men see other penises when they are not erect it can appear as if there is a big difference, and men may be likely to assume their erect penis is much smaller when compared to others.
Male porn stars are often chosen specifically because they have larger than average penises. Also, there are a variety of techniques used to make penises look bigger on camera. Lighting, camera angle, and even shaving of pubic hair can all make things look bigger on camera.
Problems with research on average penis size
Determining what the average penis size is seems like it shouldn’t be that complicated. It’s a physical body part, you measure it, and repeat hundreds of thousands of times around the world, then take an average. Unfortunately, arriving at an accurate idea of what is an average penis size, is more complicated. Some of the problems with figuring out average penis size include:
Is penis size considered to be the length, the girth, or both?
When measuring penis length, where do you start?
Is penis girth measured at the base of the penis, at the glans (head), or around the shaft?
Are the people measured in these studies representative of the general population?
Do all studies include measurements taken by others, or self-reported measurements (which are historically bigger than measurements reported by others)?
Different studies answer these questions differently, which makes arriving at a single average penis size almost impossible. Also, many researchers believe that those who are willing to participate in a study about penis size may have larger than average penises, which would also skew the results.
R

sex with the lights on


By Ducky Doolittle
Strictly speaking, this isn't just a sex book for people in relationships, but as one of my favorite books it ends up on many of my top lists. Ducky Doolittle has traveled the country for years giving entertaining and educational workshops on every sexual topic under the sun. Her book, which is subtitled "200 Illuminating Sex Questions Answered," is written as an extended Q& A session. It gives to-the-point sex advice and guidance with humor and compassion. Everyone benefits from an encounter with Ducky Doolittle, and this book offers the reader 200 such opportunities. 320 pages, 2006.

the multi orgasmic couple


In this witty guide, a Taoist sexuality expert offers advice to couples on harmonizing two unique sexual personalities so that both partners may increase the frequency, duration, and intensity of their orgasms. Encouraging readers to incorporate spirituality into their sex lives, he suggests that ultimate satisfaction is only obtainable after two lovers identify and accept each others' souls. The artist who illustrated the original THE JOY OF SEX supplements the instructive text with line drawings.

viagara

Wednesday, February 6, 2008

When Good Drugs Lead to Bad Sex

When Good Drugs Lead to Bad Sex
Lost That Lovin' Feeling? It Could Be Your Medicine.

WebMD Feature

April 16, 2001 -- One in four American adults has high blood pressure, putting them at risk for heart attack and stroke. Nearly one in 10 suffers from a depressive illness. Luckily, an expanding array of prescription drugs is available to help treat and control both conditions.


The bad news? As these drugs lower blood pressure and lift mood, they can also mess up normal sexual functioning. So while a given medicine might restore physical and mental health, it can also spark erectile dysfunction, lack of interest in sex, and the potential destruction of a relationship.


The key, say doctors who have studied drugs for hypertension and depression, is to seek help from a physician who is up to date on what treatments are out there and who is willing to work to find the best ones for you . Together, you can choose one that will keep you as healthy as possible while doing the least damage -- or perhaps none at all -- to your sex life.


Lowering pressure


The search for what doctors call "high-yield, low-risk" treatment of high blood pressure has been going on for decades, writes Peter Rudd, MD, a professor of medicine and chief of the division of general internal medicine at Stanford (California) University Medical Center, in an editorial published in the April 1, 2000, issue of the American Journal of Medicine.


In recent years, the old standbys -- thiazide diuretics (such as HCTZ, Maxide) and the beta-blocker drugs (such as Lopressor) have been joined by a tongue-twisting litany of other drug classes. You will likely hear your doctor refer to other types of blood pressure-lowering drugs known as alpha-blockers (Regitine, Dibenzyline), calcium antagonists (Cardizem, Plendil), angiotensin-converting enzyme (ACE) inhibitors (Lotensin), angiotensin II receptor antagonists (Cozaar), and direct vasodilators (Minoxidil, Apresoline). Each works differently to lower pressure.


And despite that smorgasbord of drugs, Rudd tells WebMD, the truth is there is much yet to be learned about the effects of blood pressure-lowering drugs on sexual functioning.


And in women, that goes double, as the "data about female dysfunction is scant," he says.


Physicians do have a good idea of how some of the blood pressure-lowering drugs affect some sexual functioning. Beta-blockers, for instance, can reduce stimulation to the erection center.


Studies have yielded mixed results about which antihypertensive drugs to avoid if you want to keep some romance in your life. Several have shown, for instance that diuretics and beta-blockers are associated with more sexual side effects, according to Rudd.


Despite that, he says, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure continues to recommend those drugs first.


"Those two drugs classes have been shown to reduce heart attack, stroke, and other major end points of high blood pressure," Rudd adds. But it can be a tradeoff.


For instance, he says, ACE inhibitors, shown in some studies to be less likely to cause sexual problems, are also more expensive.


Not all of the studies paint a bleak picture of the old standby drugs, however. For instance, a study published in the same issue of American Journal of Medicine that carried Rudd's editorial found no difference in sexual function between 312 men and women randomly placed on either the beta-blocker Inderal or an inactive placebo drug.


It's difficult to predict who will and won't notice an effect on sexual functioning after beginning blood pressure-lowering drugs, Rudd says. But one study published in the May 1999 issue of Pharmacotherapy found that nearly every first-line antihypertensive treatment (which includes diuretics and beta-blockers) has been reported to cause some degree of erectile dysfunction. But sexual problems can also increase with age and as other diseases set in, so it's even more difficult to pinpoint exactly what percent of problems can be blamed on the drugs.


A physician should mention the possibility of side effects when prescribing a blood pressure-lowering drug, Rudd says, but encourage a patient to try it before dismissing it because of potential effects. "The only way to be sure," he tells patients, "is to take a trial of it."


If sex life is affected, doctors can consider many options: reduce the dose, switch to another drug, or suggest lifestyle modifications such as exercise, which could help lower blood pressure and reduce the need for medication.


Lifting mood


For physicians, treating patients with depression and sexual problems can be frustrating. For one thing, sexual problems can be both a symptom of the depression and a side effect of the medication that treats the depression, according to James M. Ferguson, MD, a psychiatrist who is founder and director of the Pharmacology Research Clinic in Salt Lake City and clinical professor of psychiatry at the University of Utah School of Medicine.


Most people suffering from depression would like to be sexually active, but about half experience a decrease in desire or performance, he writes in a review of the topic in the March 2001 issue of the Journal of Clinical Psychiatry. Antidepressants often interfere with several parts of the sexual response, he says, including an inability to achieve orgasm.


With the introduction of a new class of antidepressant medicine called selective serotonin reuptake inhibitors or SSRIs (including Prozac, Zoloft, and Paxil), many doctors thought they were associated with less impact on sexual function. But as the drugs began to be prescribed in greater numbers, reports found that nearly half of patients on SSRIs had libido or orgasm problems.


The side effects vary in terms of severity, Ferguson tells WebMD. In the review article he notes that the greatest negative effects on sex lives have been reported with Paxil and the least with Prozac -- but this comes from anecdotal reports, not careful, scientific studies, he says.


But even if an antidepressant that is associated with sexual side effects is deemed the best course of treatment, there are ways to cope, Ferguson says. For instance, a patient on Zoloft, under his doctor's supervision, might skip a dose or two before a romantic evening. Because this drug stays active for a relatively short time, this may be enough to restore normal sexual function, he says.


Other considerations


Physicians who treat hypertension and depression say they don't rule out the use of Viagra for all patients on blood pressure-lowering or antidepressant drugs. But they do select these patients very carefully and rule out certain patients. Those taking nitrate drugs, for instance, such as nitroglycerine (such as Nitrol or Nitro-Bid) for chest pain, are warned by the manufacturer, Pfizer, not to take Viagra. Others are cautioned to tell their physician about other drugs they are taking.


Doctors say they decide on a case-by-case basis, weighing the risks against the benefits.


Whether you need medication to lower blood pressure or lift your mood, find a doctor you can communicate with, agree Ferguson and Rudd.


"Get a good doctor who will work with you to find the best drug," advises Ferguson. A physician should listen to your concerns about a medication's effect on your sex life, consider switching you to another drug if possible, or reduce the dose.


If your doctor does none of the above, experts agree, it's time to doctor-shop.


Kathleen Doheny is a Los Angeles-based health journalist and regular contributor to WebMD. Her work also appears in the Los Angeles Times, Shape, Modern Maturity, and other publications

Sex drugs called avenue to HIV

Sex drugs called avenue to HIV
Makers, US agencies set to study their misuse
By Diedtra Henderson, Globe Staff September 26, 2005

WASHINGTON -- Richard Gallo's experience is shared by thousands of men who sometimes find other men through e-mail messages that read: ''Do you want to PNP?" It stands for ''party and play." To party, they take crystal methamphetamine, which reduces inhibitions but also their ability to have sex. To play, they pop Viagra at the same time. Gallo, a 28-year-old Boston resident, said he had many such sexual encounters.

That worries public health officials who say the drug combination promotes risky, unprotected sex with multiple partners.

Drug companies and government agencies, including the Food and Drug Administration, are scheduled to meet today and tomorrow in Maryland to discuss how the erectile dysfunction drugs Cialis, Levitra, and Viagra might be contributing to the transmission of HIV and other diseases.

Gallo, who worked in the porn industry, received hundreds of Viagra pills for free. After work, he popped them to party and play.

''We're talking days. Days, not hours," he said. One drug-fueled sex marathon lasted ''10 days in a row," he recalled. ''No eating, no sleeping." Gallo, now sober for a year, said taking the drugs together made him feel ''invincible."

They are also potentially deadly.

Last year, a New York man was infected by a strain of HIV that overwhelms almost every drug treatment. The source of his infection: Sex with two Connecticut men who warned him they were HIV-positive. A doctor said crystal meth impaired the New York man's decision-making.

In cities across the nation, including Boston, reports of new cases of sexually transmitted diseases between men are on the rise. One reason, some health officials say, is the misuse of Viagra.

Dr. Jeffrey D. Klausner of the San Francisco Department of Public Health said that city was poised to eliminate syphilis in 2000. Now, there are thousands of new cases. He said gay men seeking treatment for sexually transmitted diseases report an average of 18 partners in the prior two months.

His research also links erectile dysfunction drugs with risky sexual behavior and an increase in sexually transmitted diseases in Chicago, Los Angeles, and New York. Klausner said drug companies should curb free samples and limit refills of erectile dysfunction drugs, which are used by more than 20 million American men.

Klausner, who filed a citizen petition with the FDA to address problems caused by misuse of erectile dysfunction drugs, wants federal drug regulators to step up efforts to thwart their illegal distribution, perhaps calling them controlled substances.

''The FDA, actually, can do a lot," he said. ''They can require the manufacturers to do more education at the population level. They can require the manufacturers to educate the doctors and the prescribers. They can encourage the manufacturers to modify their advertising and marketing efforts."

Pfizer Inc., manufacturer of Viagra, has promoted educational outreach, including a ''safe sex" message that is more tailored to the general population than to gay men who have high-risk sex.

''We strongly support efforts to prevent the spread of STDs and HIV through education of safe-sex practices, including the use of condoms," said Michal Fishman, a Pfizer spokeswoman.

Ken Mayer, medical research director at Boston's Fenway Community Health, said an educational push targeted at gay men who use drugs to enhance sex could also help dispel the growing perception by some that HIV is a manageable, not fatal, infection.

According to the results of a recent one-year study, 18 percent of Boston men seeking treatment for a new sexually transmitted disease said they used Viagra during the preceding month. Nearly 8 percent had used crystal meth, and 10 percent had used Ecstasy, a drug that makes users feel euphoric.

But Mayer said he is uncertain whether drug companies would embrace his idea of advertising the health risks for men who use erectile dysfunction drugs in combination with other substances.

''I think there is a real reticence on the part of these companies to do this kind of advertising, because they don't want their drugs to be perceived as 'gay' drugs. But in reality, I think this data says they are," Mayer said.

Dan Shames, director of the FDA's division of reproductive and urologic drugs, is scheduled to participate in a panel at the Maryland meeting that will seek to examine who is responsible for stemming the worrisome trend. ''We're sympathetic, but not sure what our particular agency can do," Shames said.

The FDA can require stronger warnings on labels, but such instructions are geared toward prescribed use of the drugs, not for when they are taken with substances like crystal meth.

''As far as FDA and labeling is concerned, a lot of this is really, really off-label," Shames said.

Diedtra Henderson can be reached at dhenderson@globe.com.

Drugs for sexual enhancement

Sunday, February 3, 2008

I myself am not a consumer of illicit drugs. Because I still have another, better option. Optimal sexual experience.

But while I am not currently a consumer of illicit drugs, this doesn't mean that I wouldn't be a consumer of drugs. And I'm not talking drugs against headache, the flu, or constipation. I am talking drugs that enhance the pleasure one can get out of life.

My expertise as a shaman is narrow, but deep. It covers only one condition. I have no knowledge on what herbs to use in the treatment of heartburn or for the recovery from a heart attack. But I have tried virtually everything that has a reputation to improve sexual parameters.

I do not believe that my sexual function is worse than that of the average man above 50. It's just that I am philosophically so focused on sexuality that a level of sexual function that is worse than what I enjoyed in my 20s is simply not acceptable to me.

Unfortunately, many more herbs have a reputation to aid in sexual function than actually have an effect. And some of the herbs that do have a clear effect, such as yohimbe, have an awkward side effect profile. Yohimbe certainly aids erections, but it's too heavy on the heart to be a comfortable choice.

Prescription drugs also have their downsides. Sure, Viagra, Levitra, and Cialis all work well to engineer erections. So does alprostadil cream. But the erections caused by each of these medications are cold. The above three do not increase sexual pleasure. I had episodes on Viagra when I just stopped in the middle of intercourse because I was bored with the whole exercise. I had an (Viagra-aided) erection all right, but totally lacked excitement.

Dopaminergics can help with sexual excitement, but for most of them, the window of opportunity isn't very wide, and one has to know what to expect.

Many dopaminergics, including sublingual apomorphine (Uprima) have a tendency to make you feel unwell. A slight nausea sets in when dopaminergics become effective, and one desires to lie down (even without a sexual partner). For many people, including me, the slight nausea is accompanied with sleepiness. Sleepiness, of course, is, in men, often accompanied by erectile ease. So, combining apomorphine (or ropinirole, or pramipexole) with a phosphodiesterase inhibitor like sildenafil will certainly produce a nice erection, and sexual excitement (in spite of the accompanying nausea) if one gets the timing right. This means, one has to start to engage in sexual intercourse at the time the dopaminergic kicks in (when the slight nausea first appears). If one misses this point, and falls asleep, even just for 15 minutes, the opportunity for sexual enhancement has passed and the combination of a dopaminergic and a phosphodiesterase inhibitor is likely even worse than just taking the phosphodiesterase inhibitor alone.

My best bet is still a combination of a cheap phosphodiesterase inhibitor (Indian Viagra) with an extract of tongkat ali, the Malaysian/Indonesian aphrodisiac.

Psychotropic Drug-Induced Sexual Dysfunction

Management of and Counseling for Psychotropic Drug-Induced Sexual Dysfunction


from Pharmacotherapy
Mary A. Gutierrez, Pharm.D.,Glen L. Stimmel, Pharm.D.



Abstract and Introduction
Abstract
Clinicians are increasingly faced with the need to identify, treat, and counsel patients regarding psychotropic drug-induced sexual dysfunction. Antipsychotic and antidepressant drugs have both rational mechanisms to explain their effects on sexual function and established literature documenting these effects. The agents have potential for causing decreased libido, delayed ejaculation, and anorgasmia. Management and counseling can be highly effective for patients taking these agents.

Introduction
Sexual response consists of three primary phases: desire, arousal, and orgasm (Table 1).[1] Normal sexual response depends on the interplay of many hormones and neurotransmitters. Altogether, it is a delicate chain of events that is easily broken. Key hormones and neuro-transmitters are dehydroepiandrosterone (DHEA), oxytocin, phenylethylamine (PEA), estrogen, testosterone, progesterone, prolactin, vasopressin, dopamine, serotonin, and acetylcholine. In addition to well-known effects of psychotropic drugs on various neurotransmitters, their effects on hormones and peptides may contribute to disruption of sexual function. The androgen DHEA, which is a precursor to testosterone, estrogen, and pheromones, has an excitatory role in limbic arousal in men and women. Drugs known to decrease DHEA include carbamazepine, phenytoin, cytochrome P450 (CYP) 3A4 inhibitors, and alcohol. Increases in DHEA may be caused by bupropion, digoxin, diltiazem, and cigarette smoking.[2]
Oxytocin's role in sexual response is primarily to facilitate attraction and touch sensation, with levels increasing secondary to touch and spiking during orgasm. Oxytocin is also responsible for postorgasm inertia and refractory period, greater in men than in women. Drug effects on oxytocin are not well established, but estrogen and yohimbine increase its levels and alcohol decreases them. Amphetamine-like PEA is a stimulant whose levels spike at orgasm and ovulation and is believed to mediate feelings of romance and love. Its levels are increased by monoamine oxidase inhibitors. Prolactin directly inhibits sexual desire, arousal, and orgasm as well as erectile function in men. Its levels are increased by dopamine-blocking drugs (most antipsychotic drugs) and opiates and decreased by bromocriptine, testosterone, dopamine, and bupropion.

Understanding the mechanisms and neuro-transmitters responsible for each phase of sexual function allows clinicians to predict how psychotropic drugs may affect sexual response and provides the basis for developing pharmaco-logic treatments to manage drug-induced sexual dysfunction.


Sexual Desire
Sexual desire (libido) is dependent on both psychogenic stimuli, involving all five senses, and hormonal factors. In men, androgens are an essential determinant of sexual desire. Evidence shows that the threshold testosterone level required for sexual desire is lower than the normal circulating range, and levels beyond this range do not directly increase sexual desire. In both men and women, increased estrogen or an increased estrogen:testosterone ratio decreases libido. High prolactin levels decrease libido directly. Antipsychotic drugs with dopamine-blocking activity increase prolactin levels and are a common cause of reduced libido.

Sexual Arousal
Arousal in men and women requires vascular and neurologic components. Adequate arterial inflow is necessary for penile erection and, in women, pelvic vasocongestion. Penile erection requires at least a 6-fold increase in arterial inflow into the cavernosa. Changes in arteries seen with atherosclerosis, smoking, diabetes, and hypertension may lead directly to erectile dysfunction. In addition to the necessity for adequate arterial inflow, several neurophysiologic pathways mediate sexual arousal.
Penile erection results from relaxation of the arterial smooth muscle within the corpus cavernosa, allowing increased blood inflow and mechanical occlusion of venous outflow. Arteries dilate in response to peripheral cholinergic activity and release of nitric oxide from parasympathetic nerve endings onto vascular smooth muscle. Parasympathetic stimulation in women causes similar erectile tissue vasocongestion and also causes vaginal lubrication by secretion of mucus from Bartholin's glands.

As antihypertensive drugs lower blood pressure, the resulting decreased arterial inflow explains the primary mechanism of their poten-tial to cause erectile dysfunction. Drugs with sig-nificant anticholinergic effect also may negatively influence sexual arousal, and selective serotonin reuptake inhibitors (SSRIs) reduce nitric oxide synthesis, explaining their potential to impede arousal. These early findings are being investi-gated in clinical trials to determine the role of treatments such as sildenafil. Dopamine-blocking antipsychotic drugs also decrease nitric oxide synthesis, and dopamine agonists enhance it.[3]

Detumescence requires both sympathetic and a-adrenergic activity to contract arterial smooth muscle, whereas b-adrenergic activity increases venous outflow. Trazodone, the agent most com-monly associated with drug-induced priapism, is a potent a-adrenergic-blocking agent without significant anticholinergic effect.


Orgasm
Orgasm in both men and women is primarily under adrenergic control. In men, released norepinephrine acts on a-adrenergic receptors of smooth muscle of the vas deferens, prostate, and seminal vessels to contract and propel seminal fluid into the bulbar urethra (emission). Ejaculation, as well as orgasm in women, is a sacral spinal reflex mediated primarily by adrenergic activity. Oxytocin plasma levels are increased during orgasm in men and women, and oxytocin levels correlate with orgasmic intensity.

Neurotransmitters and Sexual Function
Although the effect of psychotropic drugs on various hormones is not certain, their effect on several neurotransmitters influencing sexual function is well established. Dopamine is the neurotransmitter in the mesolimbic "pleasure center." Increasing dopaminergic activity may enhance sexual response, and blocking it may compromise response. Among psychotropic drugs, many antipsychotic agents are dopamine blockers, whereas the antidepressant bupropion has mild dopamine-agonist activity. A reciprocal relationship exists between serotonin and dopamine, in that serotonin can diminish the release of dopamine in the mesolimbic area, thus decreasing sexual response. Drugs that increase serotonergic activity are most commonly associated with delayed ejaculation in men and anorgasmia in men and women. In addition, the serotonin 5-HT2 receptor may block descending pathways from the brain stem to spinal neurons and interfere with spinal reflex centers necessary for ejaculation and orgasm. This mechanism underlies the delayed ejaculation and anorgasmia seen so commonly with serotonin agonists and explains why some antidepressants with 5-HT2-blocking effects (nefazodone, mirtazapine) do not cause anorgasmia.[4]

Epilepsy Drugs May Cause Sexual Disorders

ScienceDaily (Oct. 29, 2007) — The use of antiepileptic drugs (AEDs) can lead to decreased fertility and increased incidence of reproductive endocrine disorders in both men and women. A new study published in Epilepsia investigates the effects of withdrawal from two common AEDs, carbamazepine (CBZ) and valproate (VPA), on the sex-hormones of male and female AED users.

The study finds that reproductive endocrine dysfunction resulting from AED use is reversible, even after years of treatment. After withdrawal from CBZ and VPA, sexual hormone levels returned to pre-treatment levels, and treatment-associated reproductive endocrine changes reversed.

Increases in serum testosterone concentration and decreases in estradiol, another sexual hormone, lead to improved sexual function for both men and women. Women who stopped using CBZ and VPA also saw a return to normal estrogen levels and decreases in body mass index (BMI).

“These findings provide further evidence of the potentially negative effects of epilepsy treatment on reproductive endocrine functions in men and women, but they also show that some of these changes may be reversible,” says Morten I. Lossius, author of the study

penis pills info


How Do Penis Enlargement Pills Work?
All natural penis enlargement pills are composed of combinations of herbs and other compounds designed to increase erections. They need to be taken for an extended period of time - normally a minimum three month period is recommended.
Penis pills originated from the "love herbs" and other creations that were popular during the 1970s and 1980s. They consist of herbal supplements and/or chemical compounds that act as stimulants which increase blood circulation and enlarge the erectile tissues within the penis. This results in longer, wider and much firmer erections.
Care needs to be taken though, as some of the ingredients used within some pills are best avoided. For example, clinical studies of a substance called Yohimbe (from the bark of an African tree) have shown it to increase sexual arousal in animals. Unfortunately, when used by humans, it can have unwanted side effects including sweats, hyper nervous stimulation, and it is also suspected of triggering heart attacks. It goes without saying that no products recommended on our site contain any ingredients which are detrimental in any way.
Men who are interested in Yohimbe should look to safer herbs that have similar beneficial effects,but without the adverse problems, such as the South American combination of Catuaba and Muira Puama (another pair of sexual stimulants), or Ginkgo Biloba (which has been used for over 4000 years and has been the subject of over 300 modern medical studies).
For more information on specific ingredients found in penis enhancement pills and what they actually do for your penis, read the
Ingredients listing page on this site.
These stimulants, in various combinations, have long been known to enhance sexual performance, and for engorging the penis much more than normal. South American, African, and Asian cultures have long recommended various herbs and herbal combinations to combat flagging sex drive and lost performance due to sickness and age.
Today, leading manufacturers have taken over where the love herbs left off in the 80’s, using 21st century medical science to create more effective combinations of herbs, and making penis pills available on a wider scale. One of the top performers is produced by the Albion Medical Group, and has helped 1000's of men cope with and conquer serious erectile dysfunction issues as well as helping those who simply wish to have a size and performance increase.
These problems include small penis size and poor self-image, as well as lack of potency and premature ejaculation. The medical researchers at Albion Medical are dedicated to to curing these sexually debilitating conditions, and have developed an amazing formula called
VigRX Plus.
Albion Medical has carefully tested their product and has created a formula that is fully doctor-approved. VigRx Plus is backed by a 100% satisfaction guarantee. It has consistantly come top in all of our surveys and can be found on the
Current Top 3 Brands page.

sexual health information

Maximum Sexual Performance




“Performance stands out like a ton of diamonds. Non performance can always be explained away."
Harold S. Geneen

There is no denying a great sexual performance. It stands out “like a ton of diamonds”, and a top sexual performance is undeniable. You will impress your partner and make a lasting impression that they’ll remember for a long, long time!

Penis enhancement pills can get the equipment working like a well oiled machine, but you need to sustain that performance, and here’s how to do it.



Get your head in the game

Psychological factors can also cause up to 20% of cases of erection issues. Even though there’s usually an underlying physical problem to start with, it gets made worse by anxiety, lost confidence, stress, and depression. These are the psychological factors you need to beat to maximise your sexual performance!

Stress related to work or income, or as the result of marriage issues can have a major effect on your short term sexual performance. Over the long term, stress can result in damage to the circulatory system, again key to maximum sexual performance.

Anxiety about not being able to perform tends to become a self-fulfilling prophecy, and a poor performance can lead to others until you ‘get your head back in the game’. Penis enhancement pills can help by giving you that extra little confidence to deliver a great performance once again.

Depression is a very common cause of erection issues, and can have both physical and psychological effects. Even moderate depression can physically damage a man’s sexual performance, even when he is totally aroused by and comfortable with his partner and the situation.

If you suspect stress or other psychological factors may be hindering your performance, you can use herbs (natural medicine), or see your physician to work out a program to deal with it. Either way, get these factors under control to help you perform like a champion again.



Loose the juice

Although a very common way for men and women to ‘loosen up’ on a date or after work, too much alcohol can take away from a later sexual performance – as most of us know! By drinking conservatively you will improve you ability to perform later that evening, giving yourself a better edge.

If you go too far, at some point most of us have the sense to do some damage control (i.e. drink lots of water). In addition, there are herbal mixtures with proven effectiveness in reducing the short-term damaging effects of alcohol. Chaser Pills are one such product, and are worth looking into if you wish to ‘minimize the mess’ on a night out.

The unfortunate truth is that over the long-term, heavy drinking can (and often does) lead to permanent loss in sexual function – i.e. erection problems. The penis depends on good circulation to work well. Long-term alcohol use can damage arteries and veins, so it’s not surprising that a lot of drinking can eventually lead to impotence.

Long term heavy alcohol use may cause sexual problems. Clinical studies have shown it can mess up the impulses between the brain (pituitary gland) and the sexual organs, making it difficult for the brain to signal the blood vessels in the penis to relax and produce an erection. Alcoholism can also reduce testosterone levels, lowering both sexual drive and function.

Now, a great number of people drink socially without ever experiencing difficulties. However, if you are experiencing some form of sexual dysfunction it may be wise to keep it down a bit in the name of maintaining your performance. Loosen up on the juice, and pump up your performance!



What’s up doc?

It goes pretty much without saying that recreational drug use can and does lead to lower sexual performance, but SOME PRESCRIPTION DRUGS can also affect sexual performance if not managed carefully.

The prescription drugs to watch for are primarily those for high blood pressure, depression, spinal cord injury, and diabetes. Consult with your doctor if you are taking any of these medications that could affect your sexual performance, and have them adjust the dosages.

Another advantage of the ingredients in herbal enlargement pills is that they usually don’t conflict with prescription drugs, making them a safe option for men on other meds. Check with your physician first, but herbal sexual improvement products are very safe to use and in fact improve your overall health!



Healthy lifestyle – just eat and sleep a little better!



Surprise, surprise, but there’s a great deal to be said for simply eating and sleeping a little better than you do now. We’re not suggesting a ‘total life turnaround’, as most of us aren’t willing to do this unless there are other dire health issues such as heart disease. But even a LITTLE change can help a LOT!

You can have a major impact on your sexual performance just by getting an extra hour of sleep per night, eating a little less fast food, and getting some fruits and veggies into your diet here and there. You probably hear this 3 times a day – but there is a reason for this vital message.

All this sounds pretty straight forward, but have you ever considered doing it? The results might please you…

By shedding a few pounds and reducing your cholesterol levels you increase the health of your entire circulatory system (directly improving blood flow to the penis), not to mention stabilizing blood sugar levels – even non-diabetics can get erection problems due to problems with their insulin levels.

By eating smaller, healthier meals a little more regularly (4 – 5 smaller meals per day) you can dramatically reduce your chances of acquiring a diabetes-like condition during middle age – a major culprit in temporary impotence.

Another advantage of eating regularly is better energy levels overall. With greater reserves you’ll feel stronger, and be able to perform longer for those marathon sexual adventures (you do still have them, don’t you?). More energy = better performance.

In short, better health through small a couple of small lifestyle changes you can dramatically increase your sexual performance.



Whether with different partners or an established mate, having a satisfying sex life depends on two things – the right moves, and performance ability. You’ve got to have the physical ability to deliver.

Through a slightly healthier (not impossible) lifestyle and good ‘sexual nutrition’, you’ll always have strong, solid erections and plenty of energy to deliver.

Here’s to your overall sexual health