Все о мигрени – All about migraines

Getting expectations clear and discussing them in detail with the therapist and your partner is an essential part of sex therapy. If you can get erections in some situations but not others, it’s realistic to explore what is happening in the situations when you don’t become erect. For example, a man who feels he «should» have sex whenever his partner is willing may discover that just removing that requirement solves the problem. If you have a physical illness which plays a role in your potency, your expectations of what constitutes success must, of course, be defined with those facts in mind. A sex therapist will probe and help you define what constitutes success for you. It’s important to get this clear before you embark on a program of therapy, so everyone knows the goals and objectives of the program.

Sometimes a couple comes in for one problem, and in the process of defining the man and woman’s expectations, different concerns emerge. Harry’s announced reason for wanting sex therapy was his inability to consistently maintain an erection. This 57-year-old man suffered from high blood pressure and had to take medication for this condition. He also had been diagnosed recently as diabetic, a fact he found very difficult to accept.

Harry’s first marriage had ended in divorce. In discussions with the therapist it became clear that Harry blamed his erection problem for the breakup of this relationship. He was convinced that the same thing might happen again with his second wife, Shirley, a vivacious 54-year-old who also had been married before. For the most part, Harry and Shirley considered themselves a happy couple. But increasingly, Harry was fixated on his «sexual failures.» He was convinced that Shirley would reject him just as his first wife had—and that his erectile problems were to blame.

Harry felt an erect penis was necessary to satisfy a woman, and he was quite surprised when the therapist explained in detail that this was not true. He was even more surprised when Shirley, encouraged by the therapist, explained that she was not overly concerned with Harry’s erection problem.

When Harry lost potency, Shirley’s usual comment was, «Don’t worry about it.» Harry interpreted this remark as a well-intended solace for his failure. But Shirley meant her words, and more. Her first husband had been, she explained, a «slam-bam thank you ma’am» kind of guy, and Shirley was quite happy to be cuddled, kissed and caressed. She wanted to be physically close to Harry, but she did not feel especially deprived by Harry’s loss of potency. What she did want was physical affection. Harry’s preoccupation with intercourse as the only «real» sex was troubling her.

What Harry and Shirley learned in sex therapy helped their fundamentally sound relationship. They learned to communicate more clearly and directly. Each learned to say what was wanted without confusing the other. Relieved of the self-induced pressure to always produce an erection, Harry relaxed and found his erections improved. He also began taking better care of himself, because he could accept more easily the changes his diabetes required in his life.

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If you thought that stress couldn’t tamper with your life any more than it already has, consider this. Stress can dampen sexual arousal. An action that includes the surging of blood, increased heart rate, and erection, arousal depends, to a great extent, on a number of various hormones to spark specific reactions in the body.

But there are other hormones discharged from the adrenergic system—epinephrine and norepinephrine, especially—that can effectively shut down sexual response. Whenever you are under stress, no matter what the source is, these hormones begin to course through your veins, directing blood flow to the heart and major muscles and, therefore, away from the genitals, in both men and women. This results in increased heart rate and blood pressure, two physical factors that can contribute to lowered libido and performance.

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Based on extensive research by scientists, as well as my own experience, I have put together a list of seven supplements which can improve penile health. These substances have other wide-ranging effects. Not only can they decrease the risk of ED, they also offer increased protection against cardiovascular diseases such as atherosclerosis.

The seven are vitamin E, vitamin C, Pycnogenol, ginkgo biloba, coenzyme Q (also called Co-Q-10), ginseng, and saw palmetto. You may already be taking one or two of them. If so, see my recommendations to ensure that you are taking a high enough dosage to make an impact on your health. Keep in mind that you can try any or all of these supplements. But as is always the case with new remedies, consult with your doctor before you decide which to take, and in what dosage. Five out of the seven substances listed have powerful antioxidant effects (ginseng and saw palmetto have other properties). Utilizing them to your best advantage can help to ward off—or significantly diminish —the effect of one of the body’s great enemies: free radicals.

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But what about those anxiety-related situations that most men can relate to? Job performance, concern over finances, problems with teenagers at home, relationship issues with a partner—the list goes on and on, changing each day. Problems stemming from daily life are universal.

Consider the example of a thirty-four-year-old patient of mine whose job as a Wall Street trader gives him more than his share of high anxiety. It so happened that Eric’s third wedding anniversary coincided with the day of a stock market freefall. That night he went home, trying to put the awful day behind him, anticipating a sexual celebration. Only, it didn’t happen. There was no way that he could circumvent his worry over the events of that afternoon and the result was a disappointing evening.

When he called me the next morning, I understood why his erectile failure had occurred; so did he. Then he wanted to know if he could have a prescription for the pills for those times when he might need them. He is healthy and doesn’t smoke. His drinking is limited to an occasional glass or two of wine and he exercises regularly. His ED is solely anxiety-related. Why shouldn’t a man with his profile, in a loving relationship, have the fallback support he may need? Isn’t his quality of life being compromised otherwise?

For Eric, and the millions of men like him who will—if they haven’t already—experience anxiety-related ED, the pills can relieve worry and offer substantial piece of mind. Isn’t that a valid function of medicine?

I do feel, however, that the decision to provide the medication to males who are already performing at the highest sexual levels, and who have never experienced any kind of ED, must be made on a case-by-case basis. Presently, there is a lack of scientific data to support any preventive use of the oral drug. Although controlled medical studies are being planned to measure the benefits of prophylactic use—some experts are predicting that, in the near future, the drug will be taken two or three times a week, even when a man is not engaging in sex, to ensure erectile health—we may not have definitive answers for several years.

Based on my own experiences and on the extensive reports of my fellow medical colleagues, I’m extremely pleased with the profile of the medication. With the information on hand, I can weigh the merits of the drug on a risk-to-benefit ratio on a patient-by-patient basis.

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Before I provide a man with the ED medications, I have a serious discussion with him about the importance of understanding how the pills work. I make it very clear that the erection pill will allow him to I unction sexually within a relatively large window of opportunity. It does not, however, mean that the medications can cure the condition i hat caused ED in the first place. I also reiterate that more is not better. I doubling a dose will not make a belter lover. In fact, it might bring on some undesirable side effects, such as plummeting blood pressure, light-headedness, and a racing heart.

When a Patient Doesn’t Want Medication

For some people, the idea of having to take medication is less than thrilling. It signifies getting older, losing control of their bodies, and facing their mortality. Even though the ED drugs have proven to be so successful, some of my patients are still reluctant to use them. Or they use them for a while and suddenly stop. I think this is linked to the unspoken desire to feel «normal» and in control. But if a patient stops taking the drugs, thinking that he is cured permanently, he is going to subject himself to another, potentially more devastating round of failure, deflated self-confidence, and embarrassment.

Using ED medication is hardly a sign of weakness or inadequacy. On the contrary, taking it means that a man is dealing with his problem and, in fact, overcoming it in the most painless, practical way possible. It basically comes down to this: Without the drugs, junction is going to remain impaired. With them, it will be corrected.

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One group that has been largely ignored by researchers is the group of men and women who identify themselves as bisexual. That means that they are sexually attracted to both men and women. The ultimate choice of a longterm partner may well come down to broader social factors. Pauline and Sally had known each other for a few months before they decided to travel abroad together. Sally recalled, ‘Our friendship became more and more intimate over the time we were traveling. We spent twenty-four hours a day together and so we got to know everything about each other. The closeness that comes from having to rely totally on each other in a foreign country was just incredible. We had both dated only men in the past, but after it became sexual with us it added a whole new dimension. We both thought this was the most wonderful relationship we could imagine. That was until we got back home. Pauline couldn’t cope with the reactions of some of her friends and she started pushing me away, but she refused to talk about it. Eventually I just pleaded with her to tell me why. She told me she was in love with me and that I was everything she could possibly want in a partner but I wasn’t a man. The only way I could cope was to leave the country and just distract myself. About a year later I heard that she was engaged. It hurt like hell, but I hope she is happy.’

When asked if any of his clients were married men, one male prostitute answered, ‘Yeah, heaps. They open their wallets to pay me, and there are the photos of the wife and kids.’

Woody Allen looked on the positive side when he said, ‘I can’t understand why more people aren’t bisexual. It would double your chances for a date on a Saturday night.’ But the reality is not so easy. In fact it may even be more difficult to establish a sexual identity than for a person who is exclusively heterosexual or homosexual. One of the problems for people who identify as bisexual is that they may not be entirely accepted by either gay people or the ‘straight’ people. One gay man told me, ‘A lot of people who say they are bisexual are confused. They just don’t want to admit they are gay so they fool themselves.’

Oscar Wilde, the English writer Vita Sackville-West, Eleanor Roosevelt and Marlene Dietrich were all known to have had relationships with both men and women, but high profile bisexual role models were relatively scarce until Madonna decided to make a career out of it. The explicit details of her celebrated and varied exploits made it almost socially necessary to have some ambiguity of sexual preference.

Wendy identifies herself as bisexual. ‘I can have a strong physical attraction to a man or a woman but I feel more of an emotional intensity with a woman, so those are the relationships that seem to work best for me. Trouble is, because I have the physical need for both but the emotional energy for only one, I feel I am constantly having to make a compromise. Some people ask me why I can’t be satisfied with just choosing one or the other. It’s hard to describe, but it’s like you have two quite separate libidos, each with needs of its own, and satisfying one makes no difference to the other.’

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The term ‘heavy petting’ was once in common use but it is so ambiguous that it is meaningless. It is supposed to mean any sexual activity up to but not including the penis crossing the entrance of the vagina. Unfortunately, without more detailed information it could be taken to mean kissing with

your mouth open, touching your partner’s genitals with your hands or even massaging each other without your clothes on none of which will result in pregnancy. ‘Heavy petting.’ It sounds so serious! When you think of ‘heavy’ you think of cumbersome, unwieldy, bulky, awkward, clumsy. Now while this may be a very accurate description of the early grope sessions of adolescence, it does nothing to help young people work out safe and unsafe activities, or to improve the attractiveness of non-intercourse options. It is more useful to talk about ‘outercourse’, referring to a number of ways of satisfying your physical needs, even to the point of orgasm, without the disadvantages of intercourse.

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Conflict arises when a young person’s actions go against parents’ beliefs, and this is particularly so in the context of sexuality. Parents may have to ask themselves, ‘Is it really worth declaring war?’ One area where parents’ attitudes may clash with their children is on a sexual activity with a traditional image problem. Although attitudes to masturbation have progressed a lot in the past twenty years or so, there are still some people who see it as a sin with dire consequences. However, it is now widely recognized as a natural form of sexual expression.

Around puberty both boys and girls become aware that masturbation is a sexual activity and it is an opportunity to explore your sexual responses in privacy. This is probably the first time we become aware of the ability to orgasm. One friend recalls the first time he ejaculated. T remember I was masturbating in the shower one day when I was about thirteen. I saw this white stuff coming out of the end of my penis and my erection disappeared faster than it had ever done before. I had no idea what k was. I thought I had burst something, so I spent the next hour or so checking all my bits and pieces, and nothing seemed to have dropped off. After it happened a few more times I figured it must be okay, so I stopped worrying. Then I heard a few of the boys at school joking about it, and I realized I wasn’t the only one!’

It is a frequent cause of battles within families. A friend, now in her thirties, has bitter memories of the time her mother found out she was taking the Pill. ‘I was about nineteen and I had been going out with Rick for over two years. He was a bit younger than me, but we knew we were both ready for a sexual relationship. My mother always had this expectation that I would be a virgin when I got married. That was about all she ever said about sex at all. Although I never challenged her about it, it had never been my plan. I think I’d been sexually active for about four months. I came back from a weekend away at a girlfriend’s house and Mum found my packet of contraceptive pills when she was looking through my bag for washing. Well, I couldn’t have imagined a worse reaction if she’d found out I had a terminal disease! She cried, she yelled, she called Rick all sorts of terrible names and said I was ruined and all that. I felt guilty, like I’d really let her down. For ages afterwards I had trouble having sex, like every time Rick and I got close I felt like I was hurting Mum or something. It took me years to forgive her for it, and we still never talk about anything really personal.’

The issue here is clearly one of permission to make your own choices. One of the biggest difficulties about being a parent is the ability to accept that we cannot dictate every thought, belief or action of another person, even if it is our own child. The achievement is in equipping our children to make responsible decisions for themselves.

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For some people, their earliest sexual experiences are synonymous with fear and betrayal. These people have been sexually abused in childhood and nothing in life can equal the damaging impact of this abuse on self-esteem and on the ability to enjoy lasting relationships.

Every parent needs to have power. Try getting a three year old to bed on time or negotiating a teenager’s curfew time without it! This position of authority is necessary if parents are to be able to teach, discipline, and establish trust and security for their children.

The physical relationship between parents and children is necessarily sensual. The kisses and cuddles, tickling each other, the comforting stroking of their hair when a child wakes frightened in the night by a nightmare. This is how we learn about affection, the appropriate expression of love and caring for another person that is so necessary to our emotional development. But there is a difference between appropriate expressions of affection and ‘abuse’.

What we need to try and figure out is this: At what point is the line crossed?

By abuse we mean an adult or someone bigger than the child using their power or position of authority to take advantage of that child’s trust or respect to involve the child in sexual activity. Now that might sound a bit long-winded but there are two key points — the betrayal of the child’s trust, and the sexual gratification of the adult.

In some cases the distinction is absolutely clear. Any adult coercing a child into intercourse, for example, is abusive beyond a shadow of a doubt. But there’s a huge gray area that would need to be taken case by case. Take the example of ‘exposure’. In many families, it is quite usual to keep the bathroom door open while you shower or dress. There is no sexual intention and it causes no distress. This would not be considered abusive but it is one of those sexual matters that depends on your perception. Sally is twenty-nine. ‘In my family when I was growing up, it was perfectly normal for everyone to share the bathroom. When we were little we often showered with one of our parents. When I married Jim and we had children of our own it just seemed to be the most practical way to get the kids clean. You know how much fuss they can make having their hair shampooed in the bath! We thought nothing more of it than that. But Jim’s father saw it differently. He thought it was really strange that we would shower with the children. Mind you, he’d never even undressed in front of his wife and they had been married for over forty years! He really tried to make us feel guilty about it.’

On the other hand, if the exposure was designed as a sexual turn-on for the adult then it would be abusive, as in the case of an uncle drawing a child’s attention to his erect penis. A child does not have to be physically touched to be sexually abused.

Take the example of sexually explicit language. What is appropriate in one context is quite out of line in another. When we talked about sex education for children, I pointed out how important it is to use the right words … a penis is a penis and so on. The information needs to be straightforward and honest to that extent. Answering a child’s questions about sex in a way that is understandable for their age group and sensitive to their need for information is an essential part of parenting. If the child is exposed to explicit sexual language or behavior that is forced upon them to the point of distress or goes well beyond their comprehension at that age, there is a problem. This is particularly the case if the adult derives sexual pleasure from it.

So whether a situation is abusive or not will depend on its context.

Some people will not realize the effect of abuse until later in life when they are confronted with a situation that somehow triggers a delayed reaction. A teenage girl became very upset and embarrassed when she started to hear about sex at school. She remembered that, when she was about five, a family friend easily coerced her into a ‘game’ during which she drew pictures on his penis with a felt pen. She said she thought nothing of it at the time and didn’t think of it as ‘sex’. Now that she was finding out about sex and starting to discover her own sexual feelings, she realized that the game was ‘sexual’ and she said she felt very angry and bad about it.

So it is clear that not all cases of sexual abuse involve physical force or violence. One of the very confusing aspects about looking back at sexual abuse is that it is not always a totally terrifying experience for the child at the time. There are even some sensations that they find pleasant, yet at the same time may recognize as ‘wrong’. These mixed emotions can make a survivor of abuse feel guilty that somehow they were responsible for the abuse and that they must have encouraged or seduced the perpetrator. However, on this point one truth is irrefutable: Children do not fantasize or lie about sexual abuse and they do not seduce adults.

The estimates of child sexual abuse are astonishing. One in four females and one in ten males has been sexually abused in childhood. The reasons that these figures can only be estimates is because so many cases still go unreported. Even today sexual abuse counsellors say that the numbers reported are the tip of the iceberg. One estimate puts the reporting rate at only five percent — only one in twenty — so the real facts about sexual abuse can come as quite a shock. It is vital for us all to know these facts so that we can fully understand its impact on a survivor, emotionally and sexually, and so that we can do something about protecting those who are at risk or suffering now.

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This book is the result of countless requests from my viewers, patients, colleagues, friends and students, who want to know more about sex. Not just the mechanical ins and outs of how to do it. Not just bare facts on how babies are made or how not to catch a sexually transmitted disease, but more complex issues about the way we relate to each other sexually, sensually and emotionally. These are the issues that both fascinate and confuse us.

In the enlightened nineties, when America is considering a city in space, the environment is under threat and the world is in recession, there is an even more fundamental problem, which is just as intimately linked to our very survival.

An enormous number of people are frightened of a basic function which has been around since the world began — their own sexuality.

Sex is a unique subject that can, almost in the one breath, give people great joy and great anguish. It is probably the one thing in our lives that gives us the most feelings, the most emotions across the whole spectrum.

Judging by the reaction to the television series SEX, it’s clear that the whole subject is a hornet’s nest of fears, beliefs, misconceptions, legends, ignorance and plain hypocrisy. As I see it, a lot of this stems from one false assumption — at some point in our lives we should know all there is to know about sex, and if we are parents of teenagers we should be able to answer all their questions. It can be pretty hard to admit that we don’t have all the answers. Traditional sex education was woefully inadequate. It left people with more questions than answers. ‘So what makes Dad want to put his penis in Mum’s vagina?’; ‘How long does he have to leave it there?’ The emphasis on reproduction and morality left out some absolutely vital issues … like specific genital anatomy, sexual technique, relationships and sexual orientation. The truth is, we need never stop learning.

However, making any changes to the way we teach about sex is a struggle every step of the way. At times it feels like a highwire balancing act.

The reaction of some groups, mainly religious fundamentalists, would have us return to the dark ages, when sex was a taboo subject. Their argument, that sex is a private matter between a married man and woman and should not be discussed, is fundamentally flawed.

Firstly, by denying people the right to openly discuss sex, we deny them the vocabulary to talk about any problems they might have. At the same time we deny them the knowledge and the skills they need to protect themselves against the results of ignorance and secrecy — sexual abuse, unwanted pregnancy, unhappy relationships, sexually transmitted diseases.

Many of our sexual decisions are made for us throughout our lives, but we each have the power to control our own sexual destiny. The choices we make will be influenced by the attitudes and the spoken and unspoken messages we get from our parents, teachers, peers, religious and political leaders, and the media. But to make informed decisions we need information, not a conspiracy of silence. Where sex is concerned, ignorance is not bliss, it’s not a form of contraception and it certainly isn’t a protection against sexually transmitted diseases.

Secondly, the emphasis on ‘shoulds’ and ‘musts’ is a real barrier to effective communication. These have to be two of the most overworked words in the English language. I’ve heard it called ‘musturbation’. By dictating what someone else ‘must’ or ‘should’ do, we deny them the right to come to their own conclusions and at the same time we invite rebellion. The more we appear to judge, the less likely we are able to get in touch with the way the other person is really feeling. This is particularly true of adolescents, but the same goes for any age group. That’s not to say that young people don’t need ‘spiritual guidance’. Of course they do, but they don’t need to be beaten about the ears with dogma. That just closes the subject. It is also very easy to lose sight of the fact that there is more than one belief system out there. What suits one group of people doesn’t work for others. Just as an example, some people believe you ‘should’ be celibate until you are married. Others believe that this is a recipe for marital disaster.

Some will criticize any discussion of the sheer pleasure of a good sex life. The fundamental reason for our sexual urges may be the survival of the species, but why should we make excuses for it being fun? Why should that be such a big secret? The human species is set apart from all others in that the female gets pleasure from sex, unlike any other animal. It would be a very cynical Creator who would design women with a clitoris and the ability to have multiple orgasms, and then expect her not to enjoy the experience. Yet why do so many of us deny ourselves permission to play? Traditional thought maintains that the clitoral orgasm exists to make women more receptive to vaginal intercourse and conception. Maybe it’s quite the opposite — the clitoris evolved as a natural contraceptive device so that women could satisfy their sexual needs as often as they liked without vaginal intercourse and the prospect of unwanted pregnancies.

In so many cases, fear and misconceptions about sex cause unhappiness and guilt. This gets in the way of something that is our fundamental right: a right to give and receive pleasure through a basic function. Instead of a mutual expression of love and delight, too often I see needless despair and barriers to fulfillment. Our sexuality, whatever our gender, our choice of partner, or our preferences, can be a joy to explore, rather than a burden to carry.

From the moment we take our first breath through to life’s final conclusion, our sexuality is a series of personal exclamation marks. We start to learn about it the moment we emerge from the womb and feel the softness of our mother’s breast, the warm strong touch of our father’s hand.

SEX: Confronting Sexuality outlines the fears and dilemmas confronting men and women at each stage of their physical and emotional development. During each stage of life, sexuality is either faced or ignored.

SEX: Confronting Sexuality deals with the moments in your life when sexuality must be confronted. It takes you sensitively, but openly and honestly through problems and their solutions.

With a subject as emotive and as controversial as sex, you’ll never get everyone to agree. The very least we can do is reassess our attitudes and beliefs and talk to each other. Perhaps more importantly than that, we might find new ways of listening to each other.

Exploring our sexuality is like taking a long journey. It’s a continuum, a winding country road with curves and hills, blind corners, hairpin bends and a few pot holes; then there are the long straight stretches when you can relax behind the wheel, enjoy the scenery and stop once in a while to smell the flowers. We all make the journey, no matter who we are, and we remember the important landmarks we pass along the way. SEX is a guided tour of those landmarks.

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