1/09/2009

Reynaud鈥檚 phenomenon

Raynaud's phenomenon is a disorder that affects the blood vessels in the fingers, toes, ears, and nose. It is characterized by episodic attacks, also called vasospastic attacks, that cause the blood vessels in the digits to constrict significantly. Skin discoloration occurs because an abnormal spasm...
Raynaud's phenomenon is a disorder that affects the blood vessels in the fingers, toes, ears, and nose. It is characterized by episodic attacks, also called vasospastic attacks, that cause the blood vessels in the digits to constrict significantly. Skin discoloration occurs because an abnormal spasm of the blood vessels causes a diminished blood supply to the local tissues. There is a characteristic three-phase color sequence: Initially, the digits involved turn white because of the diminished blood supply; then they turn blue because of a prolonged lack of oxygen; finally, the blood vessels reopen, causing a local flushing phenomenon, which turns the digits red.



Incidence




The most recent surveys show that Raynaud's phenomenon may affect 5 to 10 percent of the general population in the United States. Women are more likely than men to have the disorder, and approximately 75 percent of all cases are diagnosed in women between 15 and 40 years old.
Raynaud's phenomenon appears to be more common in people who live in colder climate zones, but people with the disorder who live in milder climates may have more attacks during periods of colder weather.



Types and possible causes of the phenomenon




There are two different types of Reynaud%26rsquo;s phenomenon. In medical literature, primary Raynaud's phenomenon may also be referred to as %26ldquo;Raynaud's disease%26rdquo;, %26ldquo;idiopathic Raynaud's phenomenon%26rdquo;, or %26ldquo;primary Raynaud's syndrome%26rdquo;.

* Primary Raynaud's phenomenon

This is the milder version of the disorder.





Most people affected by Raynaud's phenomenon have the primary form.
A patient with primary Raynaud's phenomenon typically has no underlying disease or associated medical problems. People who suffer only from attacks for several years, without involvement of other body systems or organs, rarely have or will develop a secondary disease later. Less than 9 percent of these develop a secondary disease later in life.

* Secondary Raynaud's Phenomenon

Although secondary Raynaud's phenomenon is much less common than the primary form of the disorder, it is significantly more serious. Patients have some underlying disease or condition that causes Raynaud's phenomenon. Connective tissue diseases are the most common cause of secondary Raynaud's phenomenon.


Possible associated connecting tissue disorders include:

* Sj%26ouml;gren's syndrome
* Dermatomyositis
* Polymyositis

Possible causes of secondary Raynaud's phenomenon, other than connective tissue diseases, are:

* Carpal tunnel syndrome
* Obstructive arterial disease
* Drug use (beta-blockers, ergotamine preparations, certain agents used in cancer chemotherapy)



Target population




People in certain occupations may be more vulnerable to secondary Raynaud's phenomenon. For example, workers in the plastics industry are greatly jeopardized because of exposure to vinyl chloride. Workers who operate vibrating tools can develop a type of Raynaud's phenomenon called vibration-induced white finger. In addition, people whose fingers are subject to repeated stress, such as typing or playing the piano, are also more vulnerable to the disorder.



Symptoms of the phenomenon




Symptoms of Reynaud%26rsquo;s phenomenon depend on the severity, frequency, and duration of the blood vessel spasm. Most patients with mild disease only notice skin discoloration after the hands or feet have been exposed to cold, but they may also experience mild tingling and numbness of the involved digit that will disappear once the color returns to normal. Only in a small percentage of the cases poor oxygen supply to the tissue can cause the tips of the digits to ulcerate. Ulcerated digits can become infected, and if lack of oxygen continues, gangrene can occur. Patients with secondary Reynaud%26rsquo;s phenomenon can also have symptoms related to their underlying diseases. Other rheumatic diseases frequently associated with RP include systemic lupus erythematosus, rheumatoid arthritis, and Sjogren's syndrome.


So, to recap, the most common symptoms are:


* A pattern of color changes in the fingers: pale, then blue, then red
* Hands may become swollen and painful when warmed
* Ulcerations of the finger pads
* Gangrene may develop in the fingers



Diagnosis of Reynaud%26rsquo;s phenomenon




It isn%26rsquo;t too hard to diagnose the condition, but it can be extremely difficult to identify its specific form.

* Nailfold Capillaroscopy: This is a useful diagnostic test, helping doctors determine the form of Raynaud%26rsquo;s. During this test capillaries are studied under strong magnification with a special type of microscope. For people with primary Raynaud%26rsquo;s phenomenon, the results of this test will be normal; the results are abnormal for those who have the secondary form.

* Antinuclear Antibody Test (ANA): This test can tell whether the body is producing special antibodies that commonly occur in people who have connective tissue diseases.

* Erythrocyte Sedimentation Rate (ESR): This test measures inflammation in the body and tests how fast red blood cells settle out of unclothed blood. Inflammation in the body will cause an elevated ESR.



Treatment of Raynaud's phenomenon




The goal of treatment is to reduce the number and severity of attacks, and to prevent tissue damage and loss in the fingers and toes. Several non-drug treatments can help decrease the severity of a Raynaud's attack.

1. A Raynaud%26rsquo;s attack should not be ignored. Taking the proper steps, both length and severity of the attack can be decreased. Running warm water over the fingers or toes, or soaking them in a bowl of warm but not hot water will warm them up. However, it has been proven that excessive heat can promote gangrene.
2. Not only is it important to keep hands and feet warm, but it is also helpful to avoid chilling any other part of the body. A patient should wear several layers of loose clothing, socks, hats, and gloves or mittens. Hats are particularly important because a great deal of body heat is lost through the scalp.
3. Nicotine causes skin temperature to drop, which might lead to an attack. All the patients should do their best to quit smoking as soon as possible.
4. Because stress might trigger an attack, particularly for people who have primary Raynaud's, a patient should learn to recognize and avoid stressful situations.
5. Patients with Raynaud's phenomenon should exercise regularly, because exercise promotes an overall sense of well-being, increases energy level, helps control weight, and promotes restful sleep.



Medicines




It is much easier to cure people with secondary Raynaud's phenomenon than those with the primary form. Keep in mind that the treatment is not always successful, however. Many health care professionals believe that the most effective and safest drugs are calcium-channel blockers. These medications relax smooth muscles, dilate the small blood vessels, and decrease the frequency and severity of attacks in about two-thirds of patients with either primary or secondary Raynaud's phenomenon.

Other medicines that can help include:

* Alpha blockers - Their primary role is to counteract norepinephrine, a hormone that constricts blood vessels
* Vasodilators %26ndash; Drugs whose primary role is to relax the blood vessels. Most common are nitroglycerine paste, applied to the fingers to help heal skin ulcers.


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Morphea Scleroderma

It is interesting that the word scleroderma means literally "hardening of the skin" which points out to the one of the possible physical effects of the disease. Localized scleroderma is referred to as morphea or linear scleroderma and does not affect the internal organs. The cause of the condition i...
It is interesting that the word scleroderma means literally %26quot;hardening of the skin%26quot; which points out to the one of the possible physical effects of the disease. Localized scleroderma is referred to as morphea or linear scleroderma and does not affect the internal organs. The cause of the condition is unknown but there are several treatment options!


Incidence of the condition



Several researches have came to the data that the incidence of morphea has been estimated as approximately 25 cases per million population per year. Of course- it is important pointing out that the actual incidence is likely higher because many cases may not come to medical attention. Two thirds of adults with morphea present with plaque-type lesions, with generalized, linear, and deep variants each accounting for approximately 10% of cases. Linear morphea predominates in pediatric patients, followed by the plaque (25%) and generalized (5%) subtypes.


Mechanism of the condition



The most important thing to know about the mechanism of this disease is that overproduction of collagen by fibroblasts in affected tissues is common to all forms of morphea. The exact mechanism by which these fibroblasts are activated is unknown. Proposed factors involved in the pathogenesis of morphea include:




  • endothelial cell injury


  • immunologic activation


  • inflammatory activation


  • dysregulation of collagen production




An autoimmune etiology is supported by the frequent presence of autoantibodies in patient with this disease!


Symptoms and types of the condition



There are two forms of scleroderma:




Localized sclerosis





Every patient should know that localized scleroderma affects mainly the skin and- it happens in different areas of the body. It may also affect muscles and bone, but it does not affect internal organs- which is the most important thing to know about this form of sclerosis.





Good thing about this form is the fact that it is usually not as severe as generalized scleroderma.
There are two types of localized scleroderma:




  • morphea


  • linear




Early morphea scleroderma has an inflammatory stage, followed by one or more slowly enlarging patches or plaques which are most commonly oval in shape and vary in size. What's also characteristic- they have a yellow center and are surrounded by a violet colored area. If we talk about the level of these skin changes- we should know that they may be depressed or slightly elevated and are seen more often on the trunk, but may also occur on the face and extremities.


Limited or localized scleroderma is commonly referred to by the acronym CREST, whose letters are the first initials of characteristics that are typically found in this syndrome:




  • Calcinosis




Every patient should know that in this condition, mineral crystal deposits form under the skin and this happens usually around the joints. Problem is also that some small skin ulcers filled with a thick white substance may form over the deposits which could be extremely difficult to treat.




  • Raynaud%26rsquo;s phenomenon




This is famous syndrome in which the fingers of both hands are very sensitive to cold, and they remain cold and blue colored after exposure to low temperatures. Although for many years experts couldn%26rsquo;t explain this phenomenon but now- experts agree that it is caused by abnormal changes in the small arteries and capillaries, which result in constriction and a temporary interruption of circulation, usually in the fingers.




  • Esophageal motility dysfunction




This serious condition happens when the muscles in the esophagus become scarred by scleroderma and do not contract normally. Patient should know that this can cause severe heartburn and other symptoms of gastroesophageal reflux disorder.




  • Sclerodactylia




Although not too many people have heard about this syndrome- the fact is that it is nothing more then simple stiffness and tightening of the skin of the fingers, a classic symptom of scleroderma.




  • Telangiectasia




In this situation, dilation of small vessels and capillaries cause numerous flat red marks on the hands, face, and tongue.




Generalized - systemic sclerosis





Important thing to know is that generalized morphea may involve almost the entire skin surface, which could sometimes turn into a really serious condition. An uncommon form of morphea is the guttate form which is characterized by multiple, small, chalk-white spots which vary in size from 1 to 10mm in diameter. The violet-colored line may surround all the spots and in cases of long duration the line may be brown or grayish. Although the fact is that localized morphea may last from a few months to many years- good thing is that a large proportion of morphea patients improve spontaneously.


Possible causes of the condition



Although some experts are claiming different- the fact is that the cause of morphea is still unknown. Experts have not uncovered any consistent etiologic factors which could possibly lead to all those different morphea subtypes which often coexist in the same patient. Some of the possible causes could be:




Radiation therapy





Several researches done in the past have shown that Morphea can occur at the localization of previous radiation therapy for different malignancies but most commonly- for breast cancer. Skin changes are developing from 1 month up to more than 20 years after irradiation.




Infection





Not too many people know that infections, such as Epstein-Barr virus infection, varicella, measles, and borreliosis, have been reported to trigger the onset of morphea and that%26rsquo;s why- they have been proposed as possible triggers. It is also important to point out that the most extensive literature focuses on Borrelia burgdorferi as a possible etiologic agent for morphea. However- the problem is that several more recent studies found no serologic evidence of Borrelia infection in patients with morphea. Morphea-like lesions have also been reported to occur after tuberculosis TBC and tetanus vaccinations.




Trauma





Some morphea patients report a history of local trauma directly preceding the onset of disease. Excessive physical exertion triggers eosinophilic fasciitis in approximately half the cases.




Genetics





A few familial cases of morphea have been reported, most commonly the disabling pan-sclerotic subtype.


Diagnosis of the condition





  • Immunoglobulin G and immunoglobulin M




It is well known that polyclonal increases in both antibody types may occur, especially in patients with linear and deep morphea.


Serum autoantibodies are commonly present in all types of morphea which could be extremely useful in making the right diagnosis!




  • Radiography




Every patient should know that radiography may be helpful in cases of linear or deep morphea in which involvement of the underlying bone is suspected.




  • Histological Findings




The histological findings of morphea and systemic sclerosis are similar, with a fundamental process of thickening and homogenization of collagen bundles.


Therapy of the Morphea Scleroderma



Although there is not yet a cure for scleroderma, there are many medications that help control it and patients should get familiar with all the options! Only problem is that some work well for some people and not at all for others.




  • Aspirin and steroids




Several researches done in the past have proven that Aspirin may be used in large doses to treat joint pain and swelling. It may be used to treat joint pain and swelling. Steroids could also be helpful because they are in fact nothing more then man-made forms of naturally occurring hormone in the body.




  • Antacids for stomach problems




The fact is that medications called antacids may be used to treat heartburn and to protect the esophagus.




  • Blood pressure medication




Blood pressure medication may be used to treat high blood pressure which is sometimes the co-occurring problem of scleroderma. Every patient should know that high blood pressure is known as the silent disease because it has no symptoms. Drugs that increase blood flow to fingers and toes may be used to treat Raynaud's phenomenon and that%26rsquo;s the most important effect!




  • Exercises




There is no doubt- it is proven that regular exercise helps improve overall health and fitness. That%26rsquo;s why -for people, who have scleroderma, it also helps keep the skin and joints flexible, maintain better blood flow, and prevent contractures. It is also important to keep the joints healthy because swollen and painful joints from stresses and strains that can make them hurt more. Lifting or carrying heavy objects, for example, can strain and hurt your joints and that%26rsquo;s why- it should be strongly avoided!




  • Skin protection




Well, everyone knows that the goal of skin protection is to keep a good supply of blood flowing to skin, and of course- to protect skin from injury. Keeping body warm helps open the blood vessels in arms, hands, legs, and feet and prevent any injury from cold to occur!


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Vasculitis

Vasculitis is a general term for a group of uncommon diseases that feature inflammation of the blood vessels. The blood vessels of the body are referred to as the vascular system. The blood vessels are composed of arteries that pass oxygen-rich blood to the tissues of the body and veins which return...
Vasculitis is a general term for a group of uncommon diseases that feature inflammation of the blood vessels. The blood vessels of the body are referred to as the vascular system. The blood vessels are composed of arteries that pass oxygen-rich blood to the tissues of the body and veins which return oxygen-depleted blood from the tissues to the lungs for oxygen. Vasculitis is characterized by inflammation in and damage to the walls of various blood vessels.


Each of the vasculitis diseases is defined by certain patterns of distribution of blood vessel involvement, particular organ involvement, and laboratory test abnormalities.


The word vasculitis is derived from the Latin %26quot;vasculum%26quot;, vessel + %26quot;- itis%26quot;, inflammation. Another term for vasculitis is angiitis. When arteries are the inflamed blood vessels, the condition is also referred to as arteritis. When the veins are inflamed, it is referred to as venulitis. There are many types of vasculitis, and vasculitis can affect people of all ages. Some age groups are affected more than others, depending on the type of vasculitis. However, all types of vasculitis are rare. Though some forms of vasculitis improve on their own, others require treatment %26mdash; often including taking medications for an extended period of time.


Possible symptoms of vasculitis



The signs and symptoms of vasculitis vary depending on which vessels and, as a result, which organ systems are affected. However, general signs and symptoms that most people with vasculitis experience include:




  • Fever


  • Fatigue


  • Weight loss


  • Muscle and joint pain


  • Loss of appetite




Classification



According to the size of vessels which are affected- this disorder could be divided into three groups:




  • Large vessel vasculitis


  • Medium vessel vasculitis


  • Small vessel vasculitis




Large vessel vasculitis



Takayasu arteritis


This is the most common large vessel vasculitis which primarily affects the aorta and its main branches.





There are 6 criteria of which three must be present for the proper diagnosis!




  • onset %26lt; 40 years


  • claudication of extremities


  • decreased pulsation of one or both brachial arteries


  • at least 10 mmHg systolic difference in both arms


  • bruit over one or both carotid arteries or abdominal aorta


  • narrowing of aorta




Giant cell (temporal) arteritis


This is one vasculitis of both large and medium vessels, primarily affecting cranial branches of the arteries arising from the aortic arch. Three out of 5 criteria should be present:




  • pain and decreased pulse of temporal artery


  • ESR %26gt; 50 mm/h


  • biopsy of affected artery which shows necrotizing arteritis with prominent mononuclear cells or multinucleated giant cells


  • onset %26gt; 50 years


  • localized headache


  • jaw claudication


  • pain and stiffness in the neck and shoulders




Medium vessel vasculitis



Polyarteritis nodosa


We are talking about one vasculitis and aneurysm formation affecting both medium and small arteries. At least 3 out of 10 criteria should be present:




  • mononeuropathy or polyneuropathy


  • diastolic blood pressure %26gt; 90 mmHg


  • elevated serum BUN or serum creatinine


  • hepatitis B infection


  • unexplained weight loss


  • skin rash- lived reticularis


  • testicular pain


  • myalgias, weakness


  • arteriographic abnormalities


  • polymorphonuclear cells in arterial wall






Wegener's granulomatosis





We are talking about one systemic vasculitis of medium and small arteries. At least 2 out of 4 criteria should be present:




  • microscopic hematuria or RBC casts


  • granulomatous inflammation in the vessels wall


  • nasal or oral inflammation


  • abnormal CXR with nodules, infiltrates, cavities






Kawasaki disease





This is one vasculitis which usually affects the children- large, medium, and small vessels, prominently the coronary arteries. Diagnosis requires fever for five days or more with at least 4 out of 5 criteria:




  • erythema of palms and soles


  • polymorphous rash


  • cervical lymphadenopathy


  • bilateral conjunctiva injection


  • injected or fissured lips




Small vessel vasculitis





Churg-Strauss arteritis





This form of arteritis affects medium and small vessels with vascular and extravascular granulomatosis. It is important to know that at least 4 criteria must be present in order to set the right diagnosis:




  • asthma


  • eosinophilia %26gt; 10% on CBC


  • mononeuropathy or polyneuropathy


  • migratory or transient pulmonary opacities on CXR


  • paranasal sinus abnormalities


  • eosinophils in artery wall






Microscopic polyangiitis





This specific condition affects capillaries, venules, or arterioles.




Hypersensitivity vasculitis





This specific vasculitis occurs usually due to a hypersensitivity reaction to a known drug. There is presence of skin vasculitis with palpable petechiae or purpura. At least 3 out of 5 criteria should be present at the time of diagnosis:




  • age %26gt; 16


  • use of possible triggering drug in relation to symptoms


  • palpable purpura


  • papular rash


  • skin biopsy showing neutrophils around vessel






Henoch-Sch%26ouml;nlein purpura





It is important that this specific purpura is due to the systemic vasculitis due to tissue deposition of IgA-containing immune complexes. Biopsy of lesions shows inflammation of small vessels. It is also important to know that this is the most common vasculitis in children. Presence of 3 or more criteria guaranties diagnosis sensitivity of 87%




  • hematuria


  • onset %26lt; 20 years


  • no new medications


  • palpable purpura


  • bowel angina


  • GI bleed






Essential cryoglobulinemic vasculitis





This is vasculitis which occur most often due to hepatitis C infection, immune complexes of cryoglobulins - proteins that consists of immunoglobulins and complement and precipitate in the cold while dissolving upon warming them up!


Possible causes of vasculitis



Every patient should know that vascular system is a very complicate an intricate network of blood vessels - veins, arteries and capillaries. Interesting thing to know about the size of the blood network is that if all blood vessels were laid end to end, they would extend the length of nearly 60,000 miles. It is well known that arteries deliver oxygen-rich blood, while veins return blood with increased amounts of carbon dioxide -a waste product of metabolism - to heart. Capillaries, the smallest blood vessels, connect the veins and the arteries and permit the transfer of fluids and nutrients to and from the surrounding tissues. Although- some things are still unknown- it is proven that, in case of vasculitis, the blood vessels become inflamed, which can cause the layers of the blood vessel wall to thicken. Logically- this narrows the blood vessels and leads to the reduction of the amount of blood and therefore oxygen and vital nutrients. These forms of vasculitis are called primary vasculitides.

Forms of vasculitis for which an underlying disease, such as- infection, is the cause are called secondary vasculitides. For instance, most cases of cryoglobulinemia vasculitis are the result of the hepatitis C virus, and the hepatitis B virus. Vasculitis can also occur as the result of some diseases of the immune system, such as rheumatoid arthritis, lupus and Sjogren's syndrome.


Diagnosis





  • Lab tests. Basic lab tests may include a CBC, chem-7, muscle enzyme, liver function tests, ESR, hepatitis seroloties, urinalysis, CXR, and EKG.


  • Electromyography. It is useful if a systemic vasculitis is suspected and neuromuscular symptoms are present.


  • Arteriography. This method is helpful in vasculitis affecting the large and medium vessels but not helpful in small vessel vasculitis.


  • Tissue biopsy. This is the gold standard of diagnosis when biopsy is taken from the most involved area.




Treatment



It is difficult to tell what the best possible treatment for this condition is simply because the treatment regimen depends on type of vasculitis, the severity of every individual case and general health of the patient. Treatments are generally directed toward stopping the inflammation and suppressing the immune system. Although some types of vasculitis are self-limiting and improve on their own, it is important to know that some of the cases involve taking one or more of the following medications:




  • Corticosteroids




Several researches done in the past have proven that treatment for many types of vasculitis consists of doses of a corticosteroid drug such as prednisone or methylprednisolone. These medications are made to suppress patient%26rsquo;s inflammatory response and reduce the inflammation! The fact is that, after the first month, doctor may gradually begin to lower the dose until patient reaches the lowest dose of corticosteroids he or she need to control inflammation.




  • Cytotoxic drugs




Unfortunately- some cases of vasculitis that are severe or that don't respond well to corticosteroids may need treatment with cytotoxic drugs. Most commonly used medications of this kind are Azathioprine (Imuran) and Cyclophosphamide (Cytoxan). These drugs suppress the inflammation in your blood vessels.




  • Nonsteroidal anti-inflammatory drugs (NSAIDs)




Several researches done in the past have proven that NSAIDs, such as aspirin and ibuprofen (Advil, Motrin, others), can be effective in treating mild symptoms of some types of vasculitis, such as polymyalgia rheumatica or Kawasaki disease.


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Take two: Safer sex (for your heart)

We talk a lot about sexual safety and safer sex here at Steadyhealth in terms of your physical health. But what about checking in to see if sex is safe for you and yours emotionally? Taking care of your emotions, looking out for risk factors in advance -- not just when they become an existing crisis...
We talk a lot about sexual safety and safer sex here at Steadyhealth in terms of your physical health. But what about checking in to see if sex is safe for you and yours emotionally? Taking care of your emotions, looking out for risk factors in advance -- not just when they become an existing crisis -- and safeguarding yourself, your partners and those around you from needless hurt and harm is just as important as doing what you can to prevent STDs, STIs and unwanted pregnancies.

Sexuality and sexual partnership is more than just physical, even when it's casual -- it involves our feelings and thoughts as well.



It seems that a lot of what we hear in terms of safeguarding our emotions -- if we hear anything at all -- in regard to sex (and remember that here at Steadyhealth, when we say %26quot;sex%26quot; we mean any number of sexual activities, not just sexual intercourse) is that either sex is okay, or it isn't, and we just shouldn't engage in it if we don't want to be hurt or hurt others. Or, that only sex within marriage is safe emotionally, but that simply isn't so: people are no less likely to become hurt by sex within marriage than they are outside it, especially if high divorce rates and spousal sexual abuse rates are any indication. To boot, marriage is neither an option nor a goal for everyone. Only seeing general options at both ends of the spectrum -- to either have sex or not to -- doesn't help us an awful lot, or give us food for thought to determine what may be risky sexual behavior for any of us when it comes to our hearts, minds and the quality of our relationships and sexual life. Sex is not something that need be hurtful, or that we have to avoid so as not to get hurt or hurt anyone else. When entered into with a solid basis of self-awareness, empathy, care, good judgment and an arsenal of accurate information, sex has no more the capacity to hurt than anything else in life, and has the capacity to be something wonderful, empowering and beneficial.



Just like using condoms, gloves and dams, and having regular sexual health care is preventative medicine to do your best to stay physically safe and healthy; being on the lookout for high emotional risks, hurtful or unrealistic situations, or potential sexual and emotional trouble is preventative medicine to stay emotionally healthy, and help those you're involved with do the same. It'd be silly and shortsighted to only give information on a sexually transmitted disease after one already has it, or to avoid looking at what we could do to lessen the likelihood of getting one in the first place. So, think of the following pages as preventative medicine for sexually transmitted infections of the emotional variety. If you get informed, keep a watchful eye and protect yourself and those you care for from the very start, you're much more likely to remain healthy and happy and sexually well, above, as well as below, the waist.



Lies in Black and White: Dishonesty and Secrecy



While on some level, sex being taboo or shameful goes way, way back in our culture, and for some makes it seem more exciting, it's really not healthy, personally or globally, to house our sexuality or sexual relationships in an environment of shame or lies. Sex surrounded by lies, dishonesty or secrecy tends, especially long-term, to be disastrous and debilitating. Emotionally, it can cause us to feel shame and regret; it can destroy our sexual relationship as well as our relationships with friends and family. In addition, when sex is performed under great secrecy, most people end up taking risks they usually wouldn't were it more honest, like not setting emotional limits and boundaries, taking chances by not using birth control or safer sex measures, by rushing things we otherwise wouldn't rush, by putting close friendships or other people's feelings at risk, or dismissing real compassion and care for others altogether.

Some dishonesty and secrecy scenarios:





  • Lying to parents, friends or family about sexual activities, experience or feelings, or hiding sexual relationships.


  • Engaging in sexual relationships %26quot;no one can know about,%26quot; such as because one or both partners already has another partner, or because one or both partners may be disapproved of by family or friends, or in GLBT relationships when one or both partners are not yet out.


  • Lying to a partner about sexual history, such as saying one is a virgin when one is not, saying one had been STD/STI tested when one has not, or stating one has had more or less past partners than one has actually had.


  • Faking or pretending orgasm, arousal or sexual interest.


  • Being dishonest about what one is seeking in the relationship, such as stating a relationship or hookup is casual or %26quot;only friends%26quot; when you want or feel far more, or stating a relationship is seriously romantic and intended to be long-term when you do not have those feelings.




Dishonesty when it comes to sex and sexual relationships only tends to breed more dishonesty. When you or your partner are dishonest with others, it's very hard to establish trust between you or know that you are able to be honest with each other. Lovers who lie to others tend to be left with the lingering thought, %26quot;If he/she can lie to her, how do I know he/she isn't lying to me?%26quot; And the thing is, you don't know, especially when it's been made clear a person can live lies readily. What it all comes down to is that dishonesty stands in the way of real communication, and communication is one of the most important things good, healthy sex and relationships require, with yourself and with others.



Everyone has a different threshold for what level of honesty or dishonesty they're comfortable with. In some scenarios, it may seem that a little dishonesty for a while may hurt people less than honesty, for instance, if you and your best friend's sister start to date, you may both be waiting a bit before you tell her, until you can find the best way to do it.





You may be having sexual relationships without yet telling your parents, because you are figuring out how to divulge without hurting them. You may even find that in order to protect yourself and a partner, you need to involve secrecy, such as in an interracial relationship in a town where such has before had violent results. Only you can really determine what is most appropriate and what you're okay with, but honesty really is almost always the best policy.



Mismatched Pairs: Unsuitable relationship models or unsuitable partners



There are lots of relationship models out there and possible, far more than just the standard monogamous two-person romantic relationship. Even the model of standard monogamy can have a lot of variations. Finding what model is best for a given relationship comes not from assuming one is a given model, but by talking to your partner to figure out what works best for the both of you in your unique and individual relationship.

But you both may not want the same things, or you may assume a model instead of agreeing on one, and either of those scenarios can land one or both of you in a model that isn't good for you. For instance, agreeing to monogamy when that really isn't what you want -- or pushing it on a partner with ultimatums when you know, or they've told you, that that isn't good for them isn't a healthy situation, as it also wouldn't be to agree for a partner to date others while seeing you when you really aren't okay with that.

Too, some partners are just unsuitable for us. Given, oftentimes two people have things in common, and things which are divergent, and that's pretty normal and workable. But you may find yourself with or attracted to someone who is already in a monogamous relationship, for instance. Or, who isn't emotionally available for what you need yourself. Or, who has very different needs than you do.

A lot of what we see in literature and the movies when it comes to relationships tend to have massive crisis points like these, where two people have something that threatens to keep them apart, or makes one person miserable or the like. But the thing is, in literature and movies, that often happens because it is a device employed to create tension and a plot for entertainment. It may look great and intense and romantic up there on the screen, but in real life, Romeo and Juliet still wouldn't work out every well, it would still be likely to end badly, and it wouldn't be half as pretty.

Again, sometimes, situations like this may be something we feel is beneficial enough that we take these risks for or deal with a period of great discomfort over. But some situations are just basically guaranteed to hurt one or both of you and other involved people. Situations like those below are good examples of dead-end or likely hurtful sexual relationships:



Partnership Potholes: Relationship Rough Spots



Every relationship has it's rough spots and periods of conflict, whether we're talking about long-term committed romantic and/or sexual relationships or even more casual scenarios, such as more casual sex, or what is recently referred to as being %26quot;friends with benefits.%26quot;

During rough times, sex can sometimes feel like a real comfort. Lots of people find that %26quot;kissing and making up%26quot; -- sex after fighting or an argument -- can be very satisfying. But it's a good idea to be wary. When your relationships are having rough patches, sometimes staying sexually involved regularly can keep us from really being able to look at the problems. Sex can also be -- intentionally or not -- employed as a tool to try and get a partner to stay when they are thinking about leaving. Sex can also give us the feeling, momentarily or long-term, that everything is okay when it is not.

That isn't to say that sexual activity during relationship rough spots or hard times in necessarily emotionally dangerous or traumatic, because it need not be. But to avoid creating even more problems, entering into denial, or manipulating our partner intentionally or unintentionally, when we have rough patches, it's best to talk with our partners about our sex life together and discuss how both of you feel about it to come to an agreement on what might be best for a given situation.



Get Real: Unrealistic expectations and scenarios



Sex can often have a lot to offer us, both with ourselves and with partners. But there are some things sex really can't give us, or that we shouldn't look to it to repair, fix or supply.





  • Sex cannot give us real self-worth, self-esteem or long-term positive body image.


  • Partnered sex cannot substitute for our own exploration or understanding of our own bodies.


  • Engaging in sex cannot give us reliable sex or sexual health information.


  • Sex in and of itself cannot provide love or emotional affection, friendship or emotional support or relationship commitment or security.


  • Sex cannot substitute for good communication.


  • Sex cannot magically turn anyone into an adult or a mature person.




Expecting sex to be like we see it in the movies or popular culture is unrealistic, and thinking it has magical capabilities is an error. In real life, it's quite a good deal different. Rarely in the movies, for instance, do we see a couple taking care of their sexual health with regular exams and testing, which a sexually active person NEEDS to do to keep themselves and their partners physically and emotionally well. Rarely in the movies do we see %26quot;quiet%26quot; orgasms, or sex that isn't awful, but isn't mind-numbing or heart-racing either, which sometimes, sex can be...just nice, but nothing to write home about. Rarely in the movies or in popular literature so we see the full spectrum of a couple or a person's sex life, and all the many, many issues that means dealing with. Rarely do we see unhappy endings to sexual conflicts. Rarely do we see couples taking a long time to wade through issues; instead, we usually see colossal fights, huge dramas, or stormy, wailing breakups. Rarely in pornography do we see normal-looking people with normal-looking bodies who have emotional needs and communicate realistically about sex. So, if we base our expectations on things like movies, books, porn or friend's accounts of their relationships (which can often be exaggerated), we're pretty much bound to end up feeling confused, lost or disappointed and will likely not be able to stay grounded in our very real relationships and sexuality and deal with them appropriately.

Finding out what is and isn't realistic usually means basing our expectations on what we see in real life, and taking our sexual relationships one step at a time, day by day, and talking with our partners throughout. It means having discussions about what each person wants and needs, and what each person is and is not able to provide. It means, in short, being really patient and keeping your ideals and fantasies in check.

The biggest unrealistic sexual expectation most people, especially young people, seem to fall into is thinking that sex can create love that is not already there. It can't, no matter how many times you have it, no matter what sexual activity you engage in, no matter if your partner tells you it can. It cannot. Sex can be one way of expressing love and care, and it can be part of love, but it can't pull a love rabbit out of a hat. Even if you can only get to there -- to understanding that sex can't make love, that one thing -- you'll have a really good handle on looking at sex realistically.



Sex For All the Wrong Reasons



It's hard to arbitrarily say what the %26quot;right%26quot; and 'wrong%26quot; reasons for sex, sexual activity and sexual relationships are, because that differs a lot from person to person. We all have our own sets of needs, priorities, desires, goals and aims, and unique relationships.

But there are reasons for having sex that simply are a recipe for disaster, for emotional upset on all sides, for disappointment, hurt or which just aren't reasonable or fair to you or to a partner. Some of those are:





  • Being sexually active primarily because others around you are sexually active, and thus, you want to fit in, or because someone is pressuring you.


  • To try and fill a void as far as self-wroth, esteem or confidence with sex.


  • To try and %26quot;trick%26quot; or manipulate a partner into giving you something you want (such as a relationship commitment) with sex or the promise of sex.


  • To avoid being alone or to feel less lonely by having a sex partner or partners


  • To get attention from parents, friends or others, to make another person jealous or envious, or to force a reaction from someone by being sexually active.


  • To %26quot;prove%26quot; one is an adult to someone by showing one can have sex.


  • To create conflict or upset via sexual choices, activities or relationships.


  • To take a sex partner when one cares little but simply wants sexual release akin to masturbation.


  • To become pregnant without consulting a partner in an effort to try and keep that partner.


  • To find out, in action, if you're ready for sex or not.


  • To %26quot;just get sex over with.%26quot;


  • To %26quot;prove%26quot; love or care to a partner, or to try and impress someone.




It's not always easy if we are sexually active for the wrong reasons to see what we're doing, and that we ARE doing it for the wrong reasons. That's why it's so important to really be as self-aware and as honest with yourself and others as you can, and when you have feelings of doubt, hesitation or anxiety, to take the time to stop and really look at them. It's also important to be kind and fair with yourself if you discover some of your reasons for being sexually active are wrong, unfair, unkind or just unrealistic -- it is a situation pretty much all of us have found ourselves in at least once (and often more than once). It happens, and it is okay, so long as we do become aware of it, and take steps to remedy our errs when we have that awareness.

And in stepping back from those mistakes or errors, we may find we or our partners get hurt in the process regardless: we may have to stop a relationship, or pull back, or spend some time alone, or set aside things that we liked doing or having a lot.



Are you already in a sexual relationship or partnership which you suspect may be emotionally unsafe or unhealthy for you or others? Give yourself a checkup:



Are you:





  • Suffering from anxiety, stress or depression, or having unusual physical symptoms, such as stomach aches, insomnia, changes in energy levels or appetite, a sudden drastic increase or decrease in sexual drive, or other physical symptoms that are not caused by an existing condition or illness?


  • Putting other important relationships or goals of yours at risk because of your sexual relationship(s)?


  • Taking risks which put you and yours in a position of sexual, physical or high emotional risk, or feeling you must make many sacrifices to have or maintain the relationship?


  • Feeling isolated from everyone BUT your partner, or having trouble thinking of others outside yourself and your partner(s)?


  • Discovering that other important parts of your life are taking a backseat to your sexual relationship(s) or suffering (your grades, your job, your family, etc.)?


  • Feeling sad or upset with sexual relationships or encounters far more than you find yourself feeling happy?


  • Feeling you must keep sexual activity, tension or issues high and escalating to maintain the relationship, using sexual activity to avoid or diffuse relationship conflicts, or, finding that you are %26quot;zoning out%26quot; during sexual activity?


  • Becoming unable to be autonomous and have a life and sense of self independent of your partner or a sexual relationship?


  • Feeling bad about yourself in general, or specifically in regard to your sexual relationship or behavior?




If you're experiencing any of these things, I'd suggest you find at least one person who is not your sex partner to talk to about the situation who you feel can be objective, maybe a friend, maybe your clergy leader or a teacher, maybe an aunt or uncle. Take some time alone, too, to really look at how you're feeling, and seek out trouble spots or conflicts. Talk to your partner as well. Making a reality check with someone else and yourself, then talking to your partner, is pretty vital and a good management tool. Things like those listed above may be a signal that your sexual relationship or behavior isn't healthy and balanced, or is doing you harm. And checking in with that possibility now and again never hurts.

It's important to remember that when we get involved sexually, we are taking risks -- physical and emotional -- no matter what. There is no such thing as a no-risk sexual scenario, no matter your age or situation. We take the risk of having our hearts broken, of being disappointed, of STD/STI transmission or pregnancy, of conflict over our sexual choices with friends or family, of finding out things about ourselves or our partners which may change our feelings or lives, amongst other things. Sexuality involves very deep intimacy and feelings and when we explore those feelings, we take risks.

That isn't to say that all risks are bad to take, and on some level, in order to also discover things that ARE healthy for us, that are beneficial and bring us joy, we do have to take risks and chances. That's the case whether we're talking about a sexual relationship or scenario, or trying out for the school basketball team, applying to colleges, or getting your first apartment. But taking risks which we know or suspect are foolhardy, which are more likely than not to harm us or others, or are grossly negative, is risking too much for too little, and sometimes for all the wrong reasons. Again, sex need not be harmful or hurtful, and can be a very positive and wonderful thing -- and when it is not, it may be because we are creating or continuing the situations and environments which make it negative for us and others. We all need to learn to avoid doing that, to be mindful of it, if we want our sexual lives and relationships to be healthy, happy and of real quality.

And isn't that what we all want? So, go on and take a big risk -- the risk of handling sexual relationships with care and patience, and with your whole health and well-being -- physical and emotional; personal and communal -- at heart.





  • Taking up with someone who already has a girlfriend/boyfriend or spouse.


  • Becoming involved with someone when it is clear that at the present time, they are not what you want or need, are not emotionally stable or available, or simply do not %26quot;mesh%26quot; with you and your life as is.


  • Planning meetings with partners whose background you do not know, or whose identity you have not or cannot verify (such as people met over the 'Net).


  • Dating a friend's ex or crush without talking to that friend first.


  • Agreeing to relationship models or relationship %26quot;rules%26quot; that you know you can't live with, or choosing partners whom you know have important things in great conflict with you (like a sexual orientation which does not include you, a religion which debases your own, a desire or lack thereof for children when you want the opposite, etc.).


  • Taking up a with a partner with whom you cannot assert yourself with or say no to readily.




Certainly what falls under this umbrella are abusive relationships; those which are physically, emotionally or sexually abusive, in any way at all. Those really have only two ways to go: you get smart and get out of them as soon as the very first incidence of abuse occurs, OR you stay in them and the abuse will escalate. And in nearly ALL cases, it will, no matter what you'd like to happen, no matter how sorry anyone is, no matter if you're told it will never happen again. It is nearly guaranteed that abuse, once it happens even once, will not only continue, it will escalate, and an abusive relationship is both physically and emotionally highly unsafe. So, the only safe option is to get out immediately, as hard as that may be to hear or do. If you find yourself there and need help getting out, get help.



As well, if a potential partner has a history of abusive behavior with others, it is best not to get involved with that person. They may appear to have gotten past it, or may have gotten help or treatment. If that is the case, and you wish to pursue a relationship, it is advisable to take thing very slowly, and stay aware and grounded.



Eyes (and mouths and ears) Wide Shut: Unwanted sexual activities and/or a lack of communication



When sexual activity is new to a person, it all can feel a bit risky, even if you're ready. And learning to talk about sex can be hard, and take a long time to master (heck, some people in their 50's are still learning; we're all always still learning). But.

A partner might suggest a sexual activity, for instance, that you just feel a strong aversion, or even a mild anxiety, to trying. Or it may be the other way around, with you wanting something that your partner is reticent to try. Sexual activity should never involve pushing, or one person doing something they don't truly want to. Ever. You can certainly have a discussion about a given activity you want to try, or if a partner is reticent, point them to more information, but mainly, when anyone is reticent, taking %26quot;no%26quot; at face value is the best policy. They or you may change minds over time, or as they or you find out more information on something. Or may not. But entering into an activity you don't really want to do or are afraid of, or pushing someone else to, is a recipe for hurt feelings, a lack of trust, and sexual and emotional trauma.

And not communicating clearly about sex, or communicating at all, can have the exact same results. Sexual trauma and anxiety can also have serious physical results on top of the emotional ones as well, creating conditions like vaginismus, which can result in long-term painful sex.

If you find that:





  • You're doing things you really don't want to do and feel you have to, or pressing your partner to do so.


  • You're engaging in high-risk sexual activities unsafely because you're afraid or reticent to insist on safe practices.


  • You or your partner either do not or cannot talk about sexual activities and feelings in any environment.


  • You cannot talk about sex with some measure of objectivity, calm and honesty.


  • Either you or your partner cannot discuss, make and keep sexual limits and boundaries you each set, or that either of you doesn't feel able to set boundaries at all.


  • You're making excuses for doing things you either don't want to do or don't want to take responsibility for, like saying oral sex %26quot;just happened%26quot; or that you %26quot;can't help but cheat%26quot; on a partner.




... Then the chances are, you're presently in, or walking into, an emotionally (and also physically) unsafe sexual scenario, and it's time to either leave it outright, or develop solid sexual communication, and sexual and emotional boundaries and limits with your partner, pronto.



The Maturity Myth: Lack of emotional readiness



All too often, being %26quot;ready for sex%26quot; emotionally is seen as a sign of maturity or a cornerstone of being %26quot;adult.%26quot; That is unfortunate, because it can keep us from really being able to realistically assess our own readiness is sexual situations and relationships, because the pervasive message is that if a person isn't %26quot;ready%26quot; they are immature. And that just isn't true.

Emotional readiness for sex isn't necessarily cumulative. In other words, I might be fully ready for one sexual scenario or relationship at when I'm 16, but NOT for a different one when I'm 42. Because all sexual situations and relationships are not the same, our readiness isn't something we develop once and always have -- it depends on the given situation we're in at any given time. Not being emotionally ready for something doesn't mean a person is immature. In fact, being able to acknowledge one's own lack of readiness is a pretty big sign of a mature and responsible person who knows how to care for themselves and others.

We talk about aspects of emotional readiness in many sexual readiness checklists. Some of the issues brought up there are potential conflicts such as:





  • Strong religious, cultural or family beliefs or convictions that sex for me, right now, is wrong.


  • An inability to take full responsibility for my own emotions, expectations and actions.


  • An inability to handle feelings of disappointment, confusion or upset.


  • Lacking an emotional support system outside one's sexual partner.


  • Being or feeling unable to separate sex from love.


  • Being unable to keep from using sex to manipulate one self, a partner, or anyone else.


  • The inability to handle unwanted consequences of sex, or changes and complications it may bring about in a relationship.


  • Being unable to emotionally withstand and manage a possible pregnancy, disease or infection, or rejection from a partner.


  • Being codependent or hyperdependent on a sexual partner for constant reassurance, attention or self-worth.




A lack of emotional readiness for sex in general, or for particular sexual activities, situations or relationships is often easier to handle than it may seem, and doesn't have to be something that necessitates a breakup with your partner. Solutions to not feeling emotionally ready can be as simple as just waiting to see if you become ready, changing factors in a situation to fit what you CAN handle and are ready for, or working on those things that stand in the way of your readiness with your partner, over time. It may also be good to consider a period of celibacy during times like these, or time away from a partner to sort out your own head. In addition, managing times like these means developing communication tools and practices so that you can learn to feel comfortable telling your partners freely, %26quot;Hey, I'm just not ready for this right now.%26quot; It also involves choosing partners who are themselves ready for that level of emotional maturity, to be flexible and patient and willing to communicate in kind.

Long-term partners learn over time to get used to the ebb and flow of a sexual relationship and nurture their partner's feelings. It's totally normal in every relationship that at certain times, one partner or the other may not feel emotionally %26quot;up to%26quot; sex or certain aspects of sex. That doesn't mean it's always easy, but if we choose to enter into relationships with people, it's something we all just learn to get used to and manage.



Read More...

Take two: Safer sex (for your heart) Part II

Partnership Potholes: Relationship Rough SpotsEvery relationship has it's rough spots and periods of conflict, whether we're talking about long-term committed romantic and/or sexual relationships or even more casual scenarios, such as more casual sex, or what is recently referred to as being "friend...

Partnership Potholes: Relationship Rough Spots




Every relationship has it's rough spots and periods of conflict, whether we're talking about long-term committed romantic and/or sexual relationships or even more casual scenarios, such as more casual sex, or what is recently referred to as being %26quot;friends with benefits.%26quot;

During rough times, sex can sometimes feel like a real comfort. Lots of people find that %26quot;kissing and making up%26quot; -- sex after fighting or an argument -- can be very satisfying. But it's a good idea to be wary. When your relationships are having rough patches, sometimes staying sexually involved regularly can keep us from really being able to look at the problems. Sex can also be -- intentionally or not -- employed as a tool to try and get a partner to stay when they are thinking about leaving. Sex can also give us the feeling, momentarily or long-term, that everything is okay when it is not.

That isn't to say that sexual activity during relationship rough spots or hard times in necessarily emotionally dangerous or traumatic, because it need not be. But to avoid creating even more problems, entering into denial, or manipulating our partner intentionally or unintentionally, when we have rough patches, it's best to talk with our partners about our sex life together and discuss how both of you feel about it to come to an agreement on what might be best for a given situation.



Get Real: Unrealistic expectations and scenarios

Sex can often have a lot to offer us, both with ourselves and with partners. But there are some things sex really can't give us, or that we shouldn't look to it to repair, fix or supply.





  • Sex cannot give us real self-worth, self-esteem or long-term positive body image.


  • Partnered sex cannot substitute for our own exploration or understanding of our own bodies.


  • Engaging in sex cannot give us reliable sex or sexual health information.


  • Sex in and of itself cannot provide love or emotional affection, friendship or emotional support or relationship commitment or security.


  • Sex cannot substitute for good communication.


  • Sex cannot magically turn anyone into an adult or a mature person.




Expecting sex to be like we see it in the movies or popular culture is unrealistic, and thinking it has magical capabilities is an error. In real life, it's quite a good deal different.





Rarely in the movies, for instance, do we see a couple taking care of their sexual health with regular exams and testing, which a sexually active person NEEDS to do to keep themselves and their partners physically and emotionally well. Rarely in the movies do we see %26quot;quiet%26quot; orgasms, or sex that isn't awful, but isn't mind-numbing or heart-racing either, which sometimes, sex can be...just nice, but nothing to write home about. Rarely in the movies or in popular literature so we see the full spectrum of a couple or a person's sex life, and all the many, many issues that means dealing with. Rarely do we see unhappy endings to sexual conflicts. Rarely do we see couples taking a long time to wade through issues; instead, we usually see colossal fights, huge dramas, or stormy, wailing breakups. Rarely in pornography do we see normal-looking people with normal-looking bodies who have emotional needs and communicate realistically about sex. So, if we base our expectations on things like movies, books, porn or friend's accounts of their relationships (which can often be exaggerated), we're pretty much bound to end up feeling confused, lost or disappointed and will likely not be able to stay grounded in our very real relationships and sexuality and deal with them appropriately.

Finding out what is and isn't realistic usually means basing our expectations on what we see in real life, and taking our sexual relationships one step at a time, day by day, and talking with our partners throughout. It means having discussions about what each person wants and needs, and what each person is and is not able to provide. It means, in short, being really patient and keeping your ideals and fantasies in check.

The biggest unrealistic sexual expectation most people, especially young people, seem to fall into is thinking that sex can create love that is not already there. It can't, no matter how many times you have it, no matter what sexual activity you engage in, no matter if your partner tells you it can. It cannot. Sex can be one way of expressing love and care, and it can be part of love, but it can't pull a love rabbit out of a hat. Even if you can only get to there -- to understanding that sex can't make love, that one thing -- you'll have a really good handle on looking at sex realistically.

Sex For All the Wrong Reasons

It's hard to arbitrarily say what the %26quot;right%26quot; and 'wrong%26quot; reasons for sex, sexual activity and sexual relationships are, because that differs a lot from person to person. We all have our own sets of needs, priorities, desires, goals and aims, and unique relationships.

But there are reasons for having sex that simply are a recipe for disaster, for emotional upset on all sides, for disappointment, hurt or which just aren't reasonable or fair to you or to a partner. Some of those are:





  • Being sexually active primarily because others around you are sexually active, and thus, you want to fit in, or because someone is pressuring you.


  • To try and fill a void as far as self-wroth, esteem or confidence with sex.


  • To try and %26quot;trick%26quot; or manipulate a partner into giving you something you want (such as a relationship commitment) with sex or the promise of sex.


  • To avoid being alone or to feel less lonely by having a sex partner or partners


  • To get attention from parents, friends or others, to make another person jealous or envious, or to force a reaction from someone by being sexually active.


  • To %26quot;prove%26quot; one is an adult to someone by showing one can have sex.


  • To create conflict or upset via sexual choices, activities or relationships.


  • To take a sex partner when one cares little but simply wants sexual release akin to masturbation.


  • To become pregnant without consulting a partner in an effort to try and keep that partner.


  • To find out, in action, if you're ready for sex or not.


  • To %26quot;just get sex over with.%26quot;


  • To %26quot;prove%26quot; love or care to a partner, or to try and impress someone.




It's not always easy if we are sexually active for the wrong reasons to see what we're doing, and that we ARE doing it for the wrong reasons. That's why it's so important to really be as self-aware and as honest with yourself and others as you can, and when you have feelings of doubt, hesitation or anxiety, to take the time to stop and really look at them. It's also important to be kind and fair with yourself if you discover some of your reasons for being sexually active are wrong, unfair, unkind or just unrealistic -- it is a situation pretty much all of us have found ourselves in at least once (and often more than once). It happens, and it is okay, so long as we do become aware of it, and take steps to remedy our errs when we have that awareness.

And in stepping back from those mistakes or errors, we may find we or our partners get hurt in the process regardless: we may have to stop a relationship, or pull back, or spend some time alone, or set aside things that we liked doing or having a lot.

Are you already in a sexual relationship or partnership which you suspect may be emotionally unsafe or unhealthy for you or others? Give yourself a checkup:

Are you:





  • Suffering from anxiety, stress or depression, or having unusual physical symptoms, such as stomach aches, insomnia, changes in energy levels or appetite, a sudden drastic increase or decrease in sexual drive, or other physical symptoms that are not caused by an existing condition or illness?


  • Putting other important relationships or goals of yours at risk because of your sexual relationship(s)?


  • Taking risks which put you and yours in a position of sexual, physical or high emotional risk, or feeling you must make many sacrifices to have or maintain the relationship?


  • Feeling isolated from everyone BUT your partner, or having trouble thinking of others outside yourself and your partner(s)?


  • Discovering that other important parts of your life are taking a backseat to your sexual relationship(s) or suffering (your grades, your job, your family, etc.)?


  • Feeling sad or upset with sexual relationships or encounters far more than you find yourself feeling happy?


  • Feeling you must keep sexual activity, tension or issues high and escalating to maintain the relationship, using sexual activity to avoid or diffuse relationship conflicts, or, finding that you are %26quot;zoning out%26quot; during sexual activity?


  • Becoming unable to be autonomous and have a life and sense of self independent of your partner or a sexual relationship?


  • Feeling bad about yourself in general, or specifically in regard to your sexual relationship or behavior?




If you're experiencing any of these things, I'd suggest you find at least one person who is not your sex partner to talk to about the situation who you feel can be objective, maybe a friend, maybe your clergy leader or a teacher, maybe an aunt or uncle. Take some time alone, too, to really look at how you're feeling, and seek out trouble spots or conflicts. Talk to your partner as well. Making a reality check with someone else and yourself, then talking to your partner, is pretty vital and a good management tool. Things like those listed above may be a signal that your sexual relationship or behavior isn't healthy and balanced, or is doing you harm. And checking in with that possibility now and again never hurts.

It's important to remember that when we get involved sexually, we are taking risks -- physical and emotional -- no matter what. There is no such thing as a no-risk sexual scenario, no matter your age or situation. We take the risk of having our hearts broken, of being disappointed, of STD/STI transmission or pregnancy, of conflict over our sexual choices with friends or family, of finding out things about ourselves or our partners which may change our feelings or lives, amongst other things. Sexuality involves very deep intimacy and feelings and when we explore those feelings, we take risks.

That isn't to say that all risks are bad to take, and on some level, in order to also discover things that ARE healthy for us, that are beneficial and bring us joy, we do have to take risks and chances. That's the case whether we're talking about a sexual relationship or scenario, or trying out for the school basketball team, applying to colleges, or getting your first apartment. But taking risks which we know or suspect are foolhardy, which are more likely than not to harm us or others, or are grossly negative, is risking too much for too little, and sometimes for all the wrong reasons. Again, sex need not be harmful or hurtful, and can be a very positive and wonderful thing -- and when it is not, it may be because we are creating or continuing the situations and environments which make it negative for us and others. We all need to learn to avoid doing that, to be mindful of it, if we want our sexual lives and relationships to be healthy, happy and of real quality.

And isn't that what we all want? So, go on and take a big risk -- the risk of handling sexual relationships with care and patience, and with your whole health and well-being -- physical and emotional; personal and communal -- at heart.



Read More...

Looking, lusting and learning: A straightforward view on pornography!

Pornography is one of those complicated, weird issues in life. A lot of people are really uncomfortable with the idea of anyone, and especially teenagers, reading, looking at, or watching pornography of any kind. When you’re a teenager, this can make it very difficult to even have a basic conv...

OnClick="window.open('article_show_image.php?img=user_files%2F8077%2FImage%2Fpornography.jpg','','left=10,top=10,width=367,height=520,menubar=no,directories=no,toolbar=no,scrollbars=yes,resizable=yes,status=no')" alt="" />Pornography is one of those complicated, weird issues in life. A lot of people are really uncomfortable with the idea of anyone, and especially teenagers, reading, looking at, or watching pornography of any kind. When you%26rsquo;re a teenager, this can make it very difficult to even have a basic conversation with the grownups in your life about pornography. It%26rsquo;s hard even to know where to go to ask questions about it. This is pretty understandable: we%26rsquo;re taught not to talk about sexual things in public, and pornography is definitely sexual.

A lot of us also grow up with the idea that pornography, or any directly arousing material, is somehow bad and wrong and that we shouldn%26rsquo;t even want to look at it. The culture that we live in isn%26rsquo;t very positive about sex or sexuality. People are taught to think of sex, and porn, as always being %26ldquo;dirty%26rdquo; and %26ldquo;icky,%26rdquo; or maybe %26ldquo;sinful%26rdquo; or just %26ldquo;ugly.%26rdquo;



Sex and porn can be many things, but most of all, they are sexual, and that makes them difficult to talk about. Sexuality is one of those things that we all have to deal with. Because it%26rsquo;s such a primal part of who we are, it tends to make us feel very vulnerable if we have to talk about it. We don%26rsquo;t want people to laugh at what we find arousing, and we don%26rsquo;t want to be punished for having desires and wants that the people around us might not like us to have. As a result, most people don%26rsquo;t talk much about what kind of sexual things they like, and they don%26rsquo;t talk much about pornography or any other sort of sexual material, either. It%26rsquo;s too personal, and it%26rsquo;s too controversial, for many people%26rsquo;s comfort!



This means that most people have a lot of questions about sexual issues like pornography that they can%26rsquo;t get good, thoughtful, answers to. We here at Steadyhealth don%26rsquo;t have all the answers (heck, we don%26rsquo;t even have all the questions!), but we can help make it a little less weird and freaky to talk about sex and porn by trying to bring some of the big questions out into the open. We think that knowing a bit more about what porn is, what it does, what it%26rsquo;s for, why people like it, what it%26rsquo;s good for, what it%26rsquo;s not good for, what kinds of problems it can create, and what good it can do for you can help you form better, more thoughtful opinions about what role pornography has, or might have, in your sexuality and your life.






What is pornography anyways?



The word %26ldquo;pornography%26rdquo; comes from two Greek words. Porne, the word for %26ldquo;prostitute,%26rdquo; and graphein, or %26ldquo;to write,%26rdquo; are combined to make a word that refers to anything that is primarily used to, or intended to, sexually arouse or excite sexual desire in people. This means that, strictly speaking, anything from a romance novel to a triple-X-rated movie could be considered %26ldquo;pornography%26rdquo; depending on whether or not someone thinks those things are sexually exciting.







This leaves a lot of room for interpretation! A lot of how people define %26ldquo;pornography%26rdquo; has depended, historically, on what sorts of things people felt were especially sexual in nature. Many of the textbooks that are used in public school Sex Education classes in 1999 would%26rsquo;ve been considered %26ldquo;pornographic%26rdquo; or %26ldquo;obscene%26rdquo; twenty or thirty years ago.



Definitions of what is %26ldquo;pornography%26rdquo; and what is %26ldquo;obscene%26rdquo; tend to change with the times, and they also can be different depending on what community you live in and what your community%26rsquo;s standards for sexual behavior are like. A lingerie catalog that showed models wearing only bras and panties might be %26ldquo;pornography%26rdquo; in one place and to one group of people, and be no big deal in another place with a different type of people who had a different set of common ethical, religious, and moral ideals.



Sometimes people like to make a distinction between %26ldquo;pornography%26rdquo; and %26ldquo;erotica,%26rdquo; saying that pornography is graphic and explicit and somehow %26ldquo;worse%26rdquo; than %26ldquo;erotica,%26rdquo; which would be less explicit and graphic by comparison, and thus more acceptable. This isn%26rsquo;t necessarily true. In some cases, what it boils down to is that people will call it %26ldquo;erotica%26rdquo; if it%26rsquo;s a kind of sexually-stimulating material they enjoy and accept, but if it%26rsquo;s not something they personally enjoy or accept, they call it %26ldquo;pornography%26rdquo; and argue that it is indecent and wrong.



On a really general level, the more explicitly sexual and graphic something is, and the more it seems to be intended to get a sexual response from the people who see or read it, the more likely that it will be considered %26ldquo;pornography.%26rdquo; While pictures of naked people may or may not be considered pornographic, it%26rsquo;s a pretty good bet that pictures of naked people (or even clothed people) engaged in sexual activities that involve the breasts, butt, or genitals will be considered %26ldquo;pornography.%26rdquo; So are most pictures and images of people%26rsquo;s bodies that are presented in a specifically sexual context, like a magazine that is presented as a pornographic or sexual magazine, where the pictures might also have texts that underscore how arousing they are supposed to be.



Where stories and other written things are concerned, the more detailed the descriptions of sexual activity are, the more likely it is to be considered %26ldquo;pornography.%26rdquo; Context is also important here. If there is, for instance, a detailed sex scene in the middle of a novel that otherwise doesn%26rsquo;t have a lot of sexual things happening in it, it probably won%26rsquo;t be considered pornography. But take that same sex scene out of the novel and put it in a book that is full of nothing but other sex scenes, and people are more likely to call it pornography.

The style in which things are done also has something to do with it. Things that seem more artistic are less likely to be considered %26ldquo;pornography.%26rdquo; Written things that refer to sex using medical terms and phrases (such as %26ldquo;vagina,%26rdquo; %26ldquo;penis,%26rdquo; %26ldquo;breast,%26rdquo; instead of %26ldquo;pussy,%26rdquo; %26ldquo;dick,%26rdquo; or %26ldquo;boob%26rdquo;) are also less likely to be considered %26ldquo;pornography.%26rdquo;

This can all be very confusing. It%26rsquo;s also controversial, and people have spent many human lifetimes fighting over what things are %26ldquo;pornography%26rdquo; and what things are not. You know how they say %26ldquo;Beauty is in the eye of the beholder?%26rdquo; The same thing is often true of pornography! The only common ground that really seems to exist is that something that is called %26ldquo;pornography%26rdquo; is considered primarily sexual in nature, and it is considered to exist primarily for the purpose of arousing sexual desire in the people who experience it.



What IS pornography for?



As the very vague definition implies, pornography is for arousing sexual desire in people. This can be any kind of sexual desire that people can feel %26shy; from tender, intimate, and emotional to raw, urgent, and heartless, and anywhere in between.

Sometimes people may have different reactions to the same piece of pornography depending on their mood. That%26rsquo;s pretty normal, because there are so many different ways to feel and be sexual. If your hormones are raging one day, you might react really strongly to a piece of pornography, and then the next day, when your hormones were a little lower-key, you might not react to that particular piece of pornography at all. Your moods can change, and so can the kinds of pornography that appeal to you.

People use pornography in different ways. Some people like to use pornography when they are masturbating, to help them fantasize as they touch themselves and give themselves sexual pleasure. Some people like to use pornography all by itself just to get aroused. Later they might masturbate or have sex with a partner, or they may just enjoy feeling aroused without feeling the need to do anything about it. Some people like to use pornography along with their partners, as a part of sex that they share together. Some people like all of these ways of using pornography, and choose the one they want at any given time based on their mood and what seems appealing to them at the time.

Sometimes, pornography can be a substitute for having a partner with whom you can be sexual. Most people go through periods in their lives when they do not have a sexual partner %26shy; that%26rsquo;s totally normal. But very few people really like feeling sexually frustrated, so often when people don%26rsquo;t have anyone in their lives with whom they can be sexual in person, they opt to use pornography to help arouse them and engage themselves sexually. Some people choose to use pornography for their sexual arousal instead of having partners, too, and for some people, that%26rsquo;s the most comfortable way to be sexual.



What are some of the problems that people can have with using pornography?



The biggest problem that people often have with using pornography is that they sometimes start to expect their own actual sex lives to be just like the pornography they use and enjoy. This is really pretty ridiculous and unreasonable! Pornography is idealistic, not realistic. Porn tends to show what people fantasize about, not what actually does happen in most people%26rsquo;s sex lives.

Pornography is basically fiction %26shy; it%26rsquo;s made up, not real. Even when you have pornography that shows real flesh and blood people having sex with each other, they%26rsquo;re still %26ldquo;putting on a show%26rdquo; for the camera. Also, pornography (no matter what kind it is) is always edited so that we see all of the good parts and very few, if any, of the bad parts.

This means that in pornography, you don%26rsquo;t encounter the kinds of normal, everyday differences, difficulties, and weirdnesses that you do in real life. In pornography, people are never in bad moods, or stressed out about school or work, or afraid that they might get pregnant or get an STD. People in pornography are also always in the mood for sex %26shy; and people in real life simply aren%26rsquo;t always in the mood for sex. Even porn stars aren%26rsquo;t always in the mood for sex just because they are always shown having sex in porn movies or magazine pictures. They%26rsquo;re real people, too, just like you and me. What you see in porn movies, in magazines, and what you read in stories is NOT real life.

Bodies in pornography are also generally not too realistic compared to what you find in real life. In most mainstream pornography, the people shown or described are young (under 30), conventionally attractive, and have very standardized bodies. For instance, women in pornography are almost always shown or described as having big, but unrealistically firm, breasts (a lot of women who are porn actresses or models have breast implants for this reason), and men in porn are usually shown/described as having really big penises. Obviously, not everybody has big breasts or a big penis! It%26rsquo;s okay to not look like, or be built like, the people you see (or whose descriptions you read) in pornography. It%26rsquo;s also perfectly okay not to use the exact sexual positions you find in pornography %26shy; many of them are not too comfortable or practical. Again, pornography is not real life!!

Sexual response is another thing that isn%26rsquo;t presented very realistically in pornography. People in real life can respond in a lot of different ways to being sexual or to having sex. In pornography, reactions are usually exaggerated a lot. In movies particularly, a lot of porn actors and actresses fake their climaxes so that it will seem like they are having tons of orgasms (and yes, they can fake male orgasms too, not just women%26rsquo;s orgasms!). In pornography, women in particular are also often shown as having orgasms from things that don%26rsquo;t give most women orgasms in real life %26shy; it%26rsquo;s a safe bet that women won%26rsquo;t normally have an orgasm just from having someone touch their breasts, for instance, or within seconds of starting to have intercourse. There%26rsquo;s a reason it%26rsquo;s called %26ldquo;acting%26rdquo;!

When people start comparing themselves or their sex lives to what they see or read about in pornography, they can often start to feel inadequate or maybe even abnormal. Sometimes people try to compare their partners%26rsquo; bodies, sexual desire, or sexual responses to what they%26rsquo;ve seen or read about in porn. Both are really unfair and useless. Pornography isn%26rsquo;t what real sex or real people are %26ldquo;supposed to be like,%26rdquo; it%26rsquo;s an idealized version of sexual fantasies. It%26rsquo;s fine to use pornography if you want to, but remember that porn is not real life and you and your partner(s) don%26rsquo;t have to %26ldquo;measure up%26rdquo; to it!



What kinds of people like pornography?



It depends on what you consider %26ldquo;pornography%26rdquo; to be, certainly, but almost everyone sometimes enjoys feeling sexually stimulated by something they read, watch, or look at. Your Aunt Gladys might love the thrilling sensations she gets from reading romance novels. You might really like watching movies with your favorite sexy superstars and imagining yourself getting to be in all the sexy romantic scenes with them. There are other options, too %26shy; a lot of people like more stereotypical kinds of pornography like explicit magazines or videos. Some people like all of these things, and more besides. It%26rsquo;s really a very wide-open question. The important thing to bear in mind is that a lot of people like a lot of different kinds of sexually stimulating, arousing kinds of music, art, pictures, movies, stories, et cetera. It%26rsquo;s not unusual or weird if you do, too.



Is it really okay to like pornography?



No one can decide for you if it is okay for you to like pornography or not. Whether or not you like pornography and whether or not you decide to make pornography part of your sexual life is a decision that only you can really make. Some people are not comfortable with certain types of pornography. Some people are not comfortable with any type of pornography. Some people are comfortable with all types of pornography. Some people like pornography but choose not to use it for various reasons. Other people have different preferences, opinions, and ideas, and people%26rsquo;s thoughts on these issues can change at different points in their lives.

You are ultimately the only person who can say if pornography is okay for you, what ways it might be okay for you, and what kinds are okay for you. Thinking about the issues in this article, and thinking seriously about what pornography means to you and what sorts of concerns it may bring up for you, is the best way to know!



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Behcet's Syndrome

Behcet's disease or Behcet’s syndrome is an extremely rare, chronic inflammatory disorder. The cause of Behcet's disease is unknown, although there have been reports of a virus found in some individuals with the disease. Researches have shown that Behcet's disease generally begins when individ...
Behcet's disease or Behcet%26rsquo;s syndrome is an extremely rare, chronic inflammatory disorder. The cause of Behcet's disease is unknown, although there have been reports of a virus found in some individuals with the disease. Researches have shown that Behcet's disease generally begins when individuals are in their 20s or 30s, although it can happen at any age. It tends to occur more often in men than in women. Most common symptoms of this condition are these recurrent ulcers in the mouth and on the genitals, as well as eye inflammation.

This condition is a multi-system disease, because it may involve all organs and affect the central nervous system, causing memory loss and impaired speech, balance, and movement. The effects of the disease may include blindness, stroke, swelling of the spinal cord, and intestinal complications. Although there is no cure for this disease, %26ldquo;incurable%26rdquo; does not mean %26ldquo;untreatable%26rdquo;. There are several ways in which the immune system can be suppressed to reduce the extra inflammation and relieve the symptoms.





Who%26rsquo;s affected?




Although Behcet's has been diagnosed in young infants and people over the age of 70, it most commonly affects people between the ages of 20 and 40. In Western Europe and North America, more women are affected than men. No-one knows for sure how many patients there are in the UK but it is estimated that there are about 2 in 100,000, that is, about 2,000 people. The disease is common in Japan, Turkey, and Israel, and less so in the United States.









Historical facts



In 1937, Hulusi Behcet, a Turkish dermatologist, described a disease characterized by inflammation of the uvea, the middle coat of the eye comprising the choroids, ciliary body, and the iris with genital and oral ulcers. Almost half a century later, Behcet's disease was recognized as a chronic multisystem disorder with vasculitis.



Possible causes




The lives of Behcet's syndrome patients are often made difficult by misunderstandings about their condition. The most common misconception is that the condition is infectious and sexually transmitted because of the ulcers on the mouth and genitals, but in fact it is not.
The cause of Behcet's disease remains unknown. Most experts are contemplating possible genetic predisposition, autoimmune mechanisms, and viral infection as possible causes which may trigger the autoimmune process, causing the body to attack its own blood vessels, making them inflamed.



Symptoms of Behcet%26rsquo;s disease




The symptoms of Behcet's syndrome depend on the area of the body affected. Inflammation target tissue includes the arteries that supply blood to the body's tissues and veins that take the blood back to the lungs.

The most common sites of inflammation include:

* retina
* brain
* joints
* skin
* bowels
* mouth
* genitals

The mouth and genital ulcers are generally painful and can range in size from a few millimeters to 2 cm. The mouth ulcers occur on the gums, tongue, and inner lining of the mouth. The genital ulcers occur on the scrotum and penis of males and vulva of women. Both types can leave scars.

Eyes: Inflammation of the eye can lead to blindness. Symptoms of eye inflammation include pain, blurred vision, tearing, redness, and sensitivity to bright lights.

Arteries: Possible complication of arterial inflammation can lead to death of the tissues depending on these vessels for oxygen supply.

Brain: Symptoms of inflammation of the brain include headaches, neck stiffness, and fever. This could be a serious complication, because inflammation of the brain and the meninges can cause damage to nervous tissue and lead to weakness or impaired function of some parts of the body.

Joints: Knees, wrists, ankles, and elbows are the most common joints affected. Symptoms occurring as complications of joint inflammation include swelling, stiffness, warmth, pain, and tenderness of joints.

Skin: Sometimes the symptoms are also present on the patient%26rsquo;s skin. It can develop areas of inflammation which appear as raised, tender, reddish areas, typically on the front of the legs. Ulcerations can appear at any location in the stomach or intestines.



Diagnosis of Behcet%26rsquo;s disease




* Physical evaluation

Behcet's syndrome is diagnosed based on the finding of recurrent mouth ulcerations combined with any two of the following: eye inflammation, genital ulcerations, or skin abnormalities mentioned above.

* Pathergy test

A special skin test called a pathergy test can also suggest Behcet's syndrome. This test consists of pricking the skin of the forearm with a sterile needle. The test suggests Behcet's syndrome when the puncture causes a sterile red nodule or pustule that is greater than two millimeters in diameter at 24 to 48 hours.

Other diagnostic tools which can help in setting the right diagnosis:

* skin biopsy
* lumbar puncture
* MRI scan of the brain
* bowel tests



Treatment of Behcet%26rsquo;s disease




There is no definitive cure for the Behcet syndrome %26ndash; there is only symptomatic treatment. The treatment depends on the severity and the location of its manifestations. Several classes of medications can relieve some of the symptoms.

Those most commonly used include:

* Steroids
Steroid gels, pastes and creams (usually cortisone) can be helpful for mouth and genital ulcers, because these steroids suppress the normal or increased inflammatory response of the body. Colchicine can also minimize recurrent ulcerations and Trental%26reg; seems to maintain the healed ulcers for up to the 29 months.

* Non-steroidal anti-inflammatory drugs
Joint inflammation can require non-steroidal anti-inflammatory drugs (such as ibuprofen%26reg; and others) or oral steroids. Sulfasalazine has been effective in some patients for arthritis.

* TNF-blocking medications
Treatment of eye inflammation is essential; patients with eye symptoms should be continually monitored by an ophthalmologist.Research has indicated successful management of resistant eye inflammation with new biologic medications called TNF. TNF blocks a protein that plays a major role in initiating inflammation; infliximab (Remicade%26reg;) and etanercept (Enbrel%26reg;) can also be helpful treat severe mouth ulcerations.

* Immunosuppressive agents
Severe disease of the arteries, eyes, and brain can be extremely difficult to treat, requiring powerful medications that suppress the immune system. These medications are called immunosuppressive agents. Most commonly used agents include chlorambucil (Leuderan%26reg;), azathioprine (Imuran%26reg;), and cyclophosphamide (Cytoxan%26reg;).

* Thalidomide
Recent studies suggest that thalidomide may benefit patients with Behcet's syndrome in treating and preventing ulcerations of the mouth and genitals. It is crucial to point out that this medication is known for several serious side effects, such as promoting abnormal development of fetal growth, nerve injury (neuropathy), and hyper-sedation.



Behcet%26rsquo;s syndrome prognosis




Unfortunately, the prognosis for Behcet's syndrome is generally poor. There has been a documented case of Behcet's lasting for 17 years. Although the disease is considered painful but not fatal, when the central nervous system is involved, severe disability and death are always possibilities. The condition is usually chronic, although remissions are possible during the course of the disease.

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