Herbal Health

If you and your partner have been experiencing sexual problems or dissatisfaction, and if you are being afflicted by one or more relationship trouble spots, chances are that you do not feel as close to each other as you once did. You may be engaging in power struggles and adding distance to your relationship by withdrawing, arguing, or withholding sex. In fact, you may have completely lost sight of each other’s positive qualities and the good things you do get from your relationship. This negative perspective makes you feel like you’re not getting enough, and so you’re likely to give less. And as you give less, your partner is likely to respond in kind. This leads to a downward spiral that leaves both of you feeling deprived.
The first step toward restoring intimacy is rediscovering the up side of a relationship that may have been going downhill for quite some time now. This may be difficult for you to do at first, because conflict, bitterness, anger, and pain are fresh in your mind. The following exercise gives you and your partner an opportunity to pay more attention to the positive elements and potential of your relationship. It asks you to take small, specific steps toward increasing the pleasure of intimate exchanges. Those steps will pave the way for the more difficult steps you may have to take later.
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The reverse of an unplanned pregnancy occasionally occurs. That is, a couple may plan to have children but find that conception does not take place. If this sterility continues, some help, or at least an explanation of the difficulty, may be obtained from a physician. There is a very simple test, consisting of an examination of the spermatozoa, which can prove whether the husband is sterile or not. In the case of the wife, it can be proved positively that one or both tubes are open, so that one may be sure that there is no obstruction which prevents the descent of the ova. It is, however, not possible to be sure that ripe ova are being extruded or that the ova extruded are normal. Sometimes sterility is due to the peculiar angle which the cervix of the uterus has in relation to the vagina. If it is inclined in such a way that the semen is not discharged directly upon the cervix, some degree of sterility is likely to exist. On the other hand, in some cases in which direct contact is usual, a woman may be sterile because of a twist in the Fallopian tubes. Tenacity of the mucus in the cervix may also cause sterility by blocking the entrance of spermatozoa. Sterility resulting from an inadequate development of the genital organs in woman, may be due to a defect in the activity of the ovaries or other related glands. There are now blood tests which can be used to determine both the absence of hormones and their low concentration. Advice may be given as to how to overcome some of these conditions, although one should not always expect results. In some cases the administration of certain ovarian extracts has been successful in developing the uterus of a sterile woman to the point that she was able to become pregnant.
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Following the phallic stage, the libido is channeled into a variety of general social activities, and, according to Freud, little advancement of psychosexual development occurs during this latency period. With the onset of puberty, however, and the further progression of sexual maturity, the libido again focuses on the genitals for sexual gratification and the release of tension. The individual who has reached this genital stage with libidinal reserves intact is now free to further develop a “normal” sexual adjustment and enjoy a genuine heterosexual adjustment. During this time, sexuality increasingly encompasses the concept of love and the establishment of a healthy, genuine heterosexual relationship.
In any of the stages described above, but in particular during the childhood stages, normal psychosexual development may be impaired as the result of insufficient or excessive libidinal gratification. Either of these experiences will hamper the adequate transition to the next stage and, ultimately, adjustment in the adult and may result in a neurosis or sexual difficulty. Thus, the many cases of inadequate adjustment or neuroses were inevitably interpreted as the end result of an unresolved libidinal or sexual conflict during childhood. For example, as we shall see in Chapter 10, homosexuality was regarded as a perversion resulting from an unresolved conflict during childhood psychosexual development.
Although this is a necessarily abbreviated description of Freud’s explanation of psychosexual development, the importance of biological determinants is clear. Many authorities (including some of his own followers) criticized the theory on a variety of grounds. In particular, Neo-Freudians have attempted to de-emphasize the libidinal determinants of psychosexual development in favor of a more socially oriented explanation. Moreover, social scientists in general have argued that Freudian theory neglects to recognize that sexual behavior is manifested within the context of the socially defined characteristics of masculinity and femininity.
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Together, BPH and Parkinson’s disease can add up to a diagnostic nightmare for a physician, because Parkinson’s disease can mimic the symptoms of BPH in three ways: One, it can produce a poorly sustained bladder contraction that leads to a drop in urinary flow rate and symptoms of urinary hesitancy. It also heightens the tone of the external urethral sphincter, which can lead to residual urine and obstructive symptoms. And, Parkinson’s disease can make the bladder muscle spastic or hyper-reflexive, which can cause irritative symptoms.

When BPH is suspected in a man with Parkinson’s disease, a doctor needs to be extremely conservative in treating the symptoms. The consequences of treating BPH symptoms in men with Parkinson’s disease are serious; in fact, one urologist believes, even persistent residual urine and recurrent urinary tract infections should not warrant a TUR in thisgroup of men. Still another complicating factor is that men with Parkinson’s disease are often taking several medications that can have significant side effects on the lower urinary tract.

So what to do? Probably the safest course of action is to start with an alpha-blocking drug, which works in two ways (a more thorough description appears earlier in this chapter): First, alpha blockers reduce resistance in the bladder outlet. They also decrease residual urine, and therefore the threshold for bladder instability and irritative symptoms. In Parkinson’s disease, the same factors that cause rigidity can affect the bladder’s ability to contract and the pelvic floor’s ability to relax when a man tries to urinate. One possibility, if this is happening to you, is to work with a physical therapist to learn techniques for relaxing your pelvic floor muscles, which might make urination easier.

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Like any surgical procedure, open prostatectomy is not without risks, the chief one being blood loss that requires a transfusion. All surgery involving anesthesia carries the risk of death, but this is extremely rare. The serious surgical complications that sometimes befall patients in the over-50 age group, such as a heart attack, pneumonia, or a blood clot in the lung, are also extremely rare. To help prevent such aftereffects, however, it’s crucial to get moving again as soon as possible after surgery—so be sure to walk, move your legs in bed, and do breathing exercises.

Other complications include epididymitis, if a precautionary vasectomy wasn’t performed during surgery; and bladder spasms (painful, uncontrollable contractions of the bladder, forcing urine out in spurts around the catheter)— which may be largely attributable to the presence of a catheter, and which should improve once the catheter is removed.

After the catheter is removed, some men may have trouble with stress incontinence—when urine leaks during certain physical activities, like running or playing golf. This may be temporary, and may resolve itself during the first few months after surgery. In rare cases, however, it is permanent, either as a result of damage to the urinary sphincter during the operation, or as the inevitable consequence of years of bladder damage, persistent bladder instability and urgency incontinence—when urine leaks as a man who urgendy has to go to the bathroom is trying to get there.

The most common aftereffect of open prostatectomy is retrograde, or “dry,” ejaculation. Impotence (difficulty achieving or maintaining an erection) may affect as many as 15 to 20 percent of men. (This is an unverifiable statistic; it’s tough to try to quantify impotence, because so many factors are involved. For more on impotence, see Chapter 8.)

Also seen, but rarely (in 2 percent of men), is a constriction of the bladder neck, called a bladder neck contracture, which is caused by scar tissue from the surgery. This can be reopened in outpatient surgery by a urologist. (Using a cystoscope, the urologist makes a few tiny cuts to relax the tight scar tissue.)

In rare cases, men may also develop a urethral stricture (scar tissue in the urethra). Most urethral strictures respond well to dilation—stretching the urethra, in one or two sessions. Stubborn strictures can also be treated with tiny incisions, like those done to ease bladder neck contractures.

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You’ve had a radical prostatectomy, and one or both bundles were preserved. Which means that the potential for erection is there. So what’s the problem? Why isn’t it happening?

The first bit of advice your doctor should give you here is, “Be patient.” Erections return gradually. Your body has been through a trauma; it needs time to recover. This doesn’t mean you should give up on sexual relations until the day you wake up with a full erection. Also, know that the erection you have two months after surgery is not necessarily the same one you’ll have two years from now. Most patients experience an improvement in their erections over time; the quality improves month by month.

Normally, men become sexually aroused, have an erection and then pursue sexual activity. But after radical prostatectomy, the stimuli that cause an erection are different; visual stimulation is not nearly as important as tactile sensation—what the penis can feel directiy. In other words, soon after surgery, the only way a man can achieve an erection is with direct sexual stimulation. This changes the sequence of events. Now, men need sexual stimulation to produce an erection sufficient for intercourse. For this reason, don’t be afraid to experiment with sexual activity—you can do no harm!

Also, if you have a partial erection, go ahead and attempt intercourse— vaginal stimulation will be the major factor that encourages further erections. So don’t wait until you have the “perfect erection.” (If you do, you could be waiting a long time and missing out on this important aspect of your life.) Use of lubrications such as K-Y jelly also will help tremendously.

At first, sexual stimulation is the major thing that produces erections in men recovering from radical prostatectomy, and because the best stimulation is vaginal stimulation, we encourage patients to use whatever erection they have to get vaginal penetration. Often they’ll notice that the erection soon becomes much firmer.

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The main side effect is enlargement of the breasts. This problem can be eliminated, however, with three low-dose treatments of radiation, given directly to the breast before estrogen is started. In high doses, DES can cause dangerous cardiovascular problems. However, when it’s taken in doses of one milligram a day, side effects such as edema (water retention, which causes swelling in the ankles) can be managed effectively with diuretics. Some physicians recommend that their patients on DES take an aspirin every day to avoid other cardiovascular side effects such as thrombophlebitis (blood clots in the legs), and also to lower the risk of a heart attack. Because of the risk of cardiovascular problems, men with a history of heart disease or thrombophlebitis should not use estrogen as their main form of treatment.

Estrogen does not cause hot flashes, although patients do develop the same problems with sexual function as men who are castrated (see “Surgical Castration,” above).

Conclusion: One milligram of DES a day is just as effective as higher doses, and one milligram of DES is just as effective as surgical castration in prolonging life.

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PSA is a good litmus test for the success of prostate cancer treatment: Soon after radical prostatectomy, a man’s PSA level should plummet—ideally, into oblivion. If it doesn’t drop that far, or if it goes away and comes back, some patients move to Plan B—external-beam radiation treatment. (This is the opposite of the situation described above, and the long-term prognosis is often different for these men.)

Radiation after prostatectomy is also used in some men who have “positive surgical margins”—if the edges of the removed tissue show cancer cells. However, there are several considerations here: One is that just because the surgical margins are positive does not necessarily mean that cancer is left behind. How can this be? When cancer reaches beyond the prostate to invade nearby tissue, it produces a dense scar tissue that acts, as one surgeon describes it, “like Super Glue.” As a surgeon removes the prostate, this thick scar tissue sticks to the surrounding cancer cells—picking them up like a lint brush. So in some cases, although the pathologist may see cancer cells at the margin—and make a judgment of “positive surgical margins”—there are no cancer cells left inside the patient; the sticky scar tissue took them all away.

A study at Johns Hopkins involved such instances, when a surgeon removed the prostate, looked at it, suspected that some cancer cells were present, went back and cut out more of the surrounding tissue. Even when the pathologist believed there was a positive surgical margin at the edge of the prostate, in 40 percent of these patients there turned out to be no cancer left behind in that adjacent tissue.

Another factor to consider here is that in patients with cancer that has extended beyond the prostate to the point where it is not possible for surgeons to remove it all, it’s a pretty likely bet that there are other cancer cells floating around elsewhere—that cancer has already escaped from this tissue near the prostate, that it has already metastasized. And that any attempts at local treatment (such as radiation to this area) will not be able to reach all the cancer. Finally, radiation after radical prostatectomy can make a man more prone to problems with urinary control and sexual function; the radiation may damage tissue already made vulnerable by the surgery.

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Like the homosexual offenders vs. children, the homosexual offenders vs. minors show no particular tendency to be the youngest, eldest, or only children.

We have previously noted that all homosexual offenders are characterized by having had poor relationships with their fathers between ages fourteen and seventeen; the homosexual offenders vs. minors have the misfortune to be the most extreme examples of this. Thirty-six per cent reported that they got along well with their fathers, but 39 per cent reported they got along badly. In short, of all groups the homosexual offenders vs. minors had the worst paternal relationship. The adjustment to the mother was better, but still below-average.

In regard to parental preference, they display the typical homosexual picture: 53 per cent got along better with their mothers, 33 per cent got along equally well with both parents, and 13 per cent had better relations with their fathers. This ratio is very close to that of the homosexual offenders vs. children. Maternal partiality is a feature shared by only a very few groups other than the homosexual offenders. Strangely, none of these mother-partial groups rate above-average in good relationship with their mothers; they cannot be regarded as “mammas’ boys.”

About 56 per cent of the homosexual offenders vs. minors came from broken homes; this is a higher figure than that for most sex offenders. As is the case of the other homosexual offenders, an unusually large proportion of the breakups occurred before the subject was five years old. On the other hand, a relatively large number occurred when the boy was ten or older; the homosexual offenders vs. minors had the second highest percentage in this age-category. The result is that the age of the average offender at the time of the breakup was 6.2 years— fairly early, but not extraordinary.

The parents of the homosexual offenders vs. minors did not get along with one another very well: half of them got along well but one third got along badly or poorly. Thus in a rank-order of parental harmony the homosexual offenders vs. minors are in fourteenth and fifteenth places.

Relatively few homosexual offenders vs. minors lived fifteen or more years in a home wherein both a husband and wife were present; 56 per cent did, but most other groups have higher percentages. Conversely, the homosexual offenders vs. minors rank high in the number of years lived in a household where the adults were all female.

With regard to companions at age ten to eleven, the homosexual offenders vs. minors had an excellent socialization with their contemporaries and particularly with girls, a happy situation that characterizes all homosexual offenders. In fact, the relatively large number and proportion of female playmates strikes one as faintly ominous when one recalls that at this age the average boy is apt to be disdainful of girls and avoids them. However, in most instances the number of girl companions was balanced by an equal number of boy companions, so that the over-all impression is one of excellent social adjustment.

Of all the groups used routinely in comparisons, the homosexual offenders vs. minors contained the largest number who had had prepubertal sex play (84 per cent). This, in terms of simple “ever vs. never” incidence, was rather evenly balanced between the heterosexual and the homosexual, 63 per cent having experienced the former and 68 per cent the latter. As one would anticipate, the homosexual offenders rank first, second, and third in a rank-order of percentages of those with prepubertal homosexual play, and the homosexual offenders vs. minors occupy the first rank. In terms of exclusiveness, somewhat more of them confined their sex play to boys than to girls, but the majority had play with both. The duration of their heterosexual play is in no way unusual, but they have the fourth highest percentage (57 per cent) who continued their homosexual play for three years or more.

An intermediate number of homosexual offenders vs. minors had prepubertal coitus, but (as is true of all homosexual offenders) the number with heterosexual mouth-genital contact is below average. Conversely, a relatively large number had homosexual masturbatory, oral, and anal experience.

In summary, one can say that the homosexual offender vs. minors is characterized by much prepubertal sex play that was more homosexual than heterosexual.

This homosexual orientation is seen in more striking form when one turns to the question of prepubertal sexual experience with adults. The homosexual offender vs. minors is intermediate, relative to other groups of sex offenders, in experience with adult females, but distinctive in experience with adult males. Proportionately more of them than of any other group received sexual advances from adult males (35 per cent), and in more instances (28 per cent) these advances led to physical contact. In this large quantity of experience with men they are like the other homosexual offenders, but slightly larger percentages were involved. These early experiences may have a causal relationship with the sex offenses many years later, but we lack proof of this.

As with all homosexual offenders, the childhood of the homosexual offender vs. minors was marred by poor health; the proportion reporting good childhood health is neither especially high nor low; a relatively large percentage described their early years as having been ones of poor health. Thus they are third from the bottom in a rank-order of prepubertal health.

Fifty-seven per cent of them masturbated before reaching puberty; this is the largest percentage manifested by any group, though a high incidence characterizes all homosexual offenders. In addition, again like other homosexual offenders, they tended to begin at an early age: slightly over half of those who masturbated before puberty began before age ten. Having the greatest incidence of prepubertal sex play and also the greatest incidence of prepubertal masturbation, the homosexual offenders vs. minors were, in preadolescence, the most sexually active group of all. This hypersexuality is a trait of all homosexual offenders. One is tempted to speculate that the strong sex drive (as indicated in the incidence of masturbation), which develops before society has made provision for heterosexual activity, may result in homosexual experiences. We do know that about one third of the boys learned of masturbation through early homosexual experience.

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Only an average number of the incest offenders vs. minors had premarital intercourse before they were eighteen, but thereafter the proportion mounts fairly rapidly to 90 per cent by age twenty. This advance is to be anticipated since premarital coitus ordinarily foreshadows marriage. However, the age-specific incidence of premarital coitus with companions is consistently moderate.

Compared with other groups, they had low coital frequencies before marriage. For example, even if we take into account only those who had premarital coitus, the average rate between twenty-one and twenty-five was once in three weeks—the second lowest frequency recorded. Mean frequencies are also quite low, always substantially less than those of the control group.

There is nothing especially interesting in the figures on their coitus with prostitutes; they tend to occupy middle positions in all the rank-orders. Prostitution increases in importance with age: in age-period 16-20 they had coitus with prostitutes about half as often as with companions, but in age-period 21-25 the frequencies are essentially equal. In the median frequency of premarital coitus with prostitutes at ages sixteen to twenty the incest offenders vs. minors rank second. However, the frequencies in this particular rank-order are so low—a matter of 3 to 11 times per year—that rank-order position is less meaningful.

While they had coitus with an average number of prostitutes before marriage (12), they had few nonprostitute coital partners—the average being five, the third smallest number recorded. This situation is in keeping with their below-average record of premarital petting.

The proportion of total sexual outlet derived from premarital coitus with companions is moderate in comparison to other groups, ranging from 12 to 30 per cent. However, the proportions derived from premarital coitus with prostitutes are quite large in age-periods 16-20 and 21-25, when these offenders rank third and first.

Like the incest offenders vs. children, a moderate number (56 per cent) claimed that lack of opportunity was a prime factor in their not having had, or having had more, premarital coitus. True, they got off to a rather late start in heterosexual activity and did not have large numbers of petting or coital partners, but any group in which nine out of every ten members had coital experience by age twenty cannot be regarded as having suffered deprivation. With regard to other restraints on premarital coitus—moral considerations, fear of pregnancy, disease, or public opinion—the incest offenders vs. minors seem about average. Relatively few (22 per cent) reported lack of interest as a major factor, but a somewhat large proportion (18 per cent, third in rank-order) were held back with their fianc?es by a desire for virgin brides.

Before closing the subject of premarital coitus, it is worth mention that these offenders more than any other group enjoyed their first coitus: 81 per cent (the largest proportion recorded) reported it as extremely enjoyable, while only 11 per cent (the smallest proportion on record) stated that it was unpleasant to mildly pleasant.

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