weight loss blog

For once, I’m going to put on my physician’s hat and give you the view from the side of people surrounding you.

So my patient has walked through the door and, in the same breath as blurting out that he’s suffering. Erectile dysfunction (ED) did a wonderful thing when they invented Viagra, but that medication so dominates the public consciousness that many men seem have never even heard about Cialis or Levitra, let alone all the other treatments that are available and may be necessary. Still even though my patients are predictable, they are at least coming through the door to get treatment. Ten years ago that did not happen. The world is a better place thanks to Pfizer Inc.

Well, my first step was to review the medical records to see if there were any immediate clues. If there are existing diseases or one of the medications currently on prescription has an ED side effect, we have solved the case before we start. I should let you in on a small medical secret. About a quarter of all the cases that we see are drug-related. Usually, we simply change the medication and the ED goes away

So what was I thinking during the question-and-answer session and the physical examination? This is growing more common but this patient isn’t complaining about any increase in thirst or appetite, his weight looks much as it was the last time we met. During the physical, I may also do a blood sugar test just to be thorough. Blood pressure tests out in the normal range, so that’s another good sign.

The questions are designed to establish whether we’re dealing with problems of desire (which could be psychological or physical), whether it’s purely ED or there are also problems with ejaculation and orgasm, and to check up on those lifestyle choices which could be the real problem.

The physical examination tries to cover as many possibilities as possible in as short a time as possible. Most men find an examination deeply embarrassing so keeping it short is a “good thing”. I’m looking for anything that might suggest a systemic problem. So, I’m obviously going to start with the penis. Some of my questions have probed whether the penis has changed shape in any way or perhaps the erection is painful. A physical examination could find evidence of lumps or the answers to the questions may reveal that the penis now bends or curves when erect, all of which could suggest Peyronie’s disease. Similarly, if the penis is not sensitive when I touch it, this may indicate possible problems in the peripheral nervous system.

If the testicles feel slightly smaller than I would expect, this can suggest a low testosterone level. Using the same idea and taking a quick overview of the body also allows me to look for any changes to the usual distribution of body hair or any enlargement to the pectorals (a polite way of suggesting that my patient may be developing small breasts). Any such abnormality can indicate problems with the hormone balance or the endocrine system. I’m also testing the pulses in both the wrists and ankles. If there are any circulatory problems, I’m likely to find a decrease pulse at the extremities.

So these are all the quick and easy explanations. In most cases, there is little to suggest the need to go on to further tests and I can then get into a discussion of the medication options. This is when the patient finally begins to look more comfortable again. We have finally come back to his original questions, except that I’m also telling him about Cialis and Levitra. Viagra may have the name, but Cialis in particular does have some interesting characteristics.

There are a lot of books on modern market, that extremely informative and popular. Students are expected to be impressed by the depth of knowledge because instead of one sentence approximating how a muscle works, there are now whole chapters devoted to the thin muscle filaments containing multiple proteins. Instead of simple engineering analogies of muscles and cables, human knowledge has become obsessed by the identification of ever more complex chemical and molecular processes. This is my wood-for-the-trees moment.

ED is now described in terms of complex chemical interactions and illustrated with wonderful diagrams. There are still all kinds of analogies with hydraulic engineering, but the sophistication of the functional analysis is breathtaking. A heterosexual couple may engage in sexual intercourse. A homosexual couple may offer mutual manual satisfaction, oral or anal intercourse. Multiple partners may engage in group sex. The greater the pleasure, the greater the incentive to engage in the activity and the greater the disappointment if success is not achieved.

Will medical treatment be asked for and a success? In part, this will be determined by the nature of the relationship. Many different social taboos would potentially be breached in any more detailed explanation. The common denominators are that the party or parties are expressing their sexuality in the ways that give them the most pleasure. Where the relationship is socially disapproved, the man may well not seek treatment at all because of fear. A physical examination might reveal different types of sexual activity, or a chance remark in the consultation might expose the forbidden practices. This is ironic. If the parties to the relationship have a strong mutual commitment and lovingly support each other, the likelihood is that the co-operation between all involved would produce excellent medical outcomes. Well-established sexual intimacy and commitment preserve the right level of desire and motivate everyone to getting a solution that works well. Were it not for online pharmacies and their willingness to supply medications like cialis without prescription, many partnerships might never be able to get appropriate treatment of any kind.

Unfortunately, many partnerships do not get treatment for the underlying causes of the dysfunction. Although most will know that the dysfunction can be a symptom of diabetes and cardiovascular diseases, fear of exposure may force the couples or groups to ignore or deny the problem until it is too late for the easy treatment represented by cialis to continue on its own. By then, the chances of an effective treatment for the underlying cause may be remote.

Step outside those situations and you are into potentially disapproved or even criminal territory. In theory, doctors are bound by duties of confidentiality, but the fear of exposure means that many men and their partners do not get treatment when the research shows that couples who are in love and share a strong commitment to their relationship are the ones who would most benefit from that treatment.

Any man who is experiencing problems of sexual performance is likely to feel worthless impotent. In other words, he feels exactly the same way that you must never feel. This underlines the basic truth that, when there are sexual problems in a relationship, both parties are affected. You must fight these problems.

How to begin

There is no right way to begin the discussion with your partner. If you have read the rest of the information on this website, you have actually taken a vital first step because you have begun to learn about the problem and its causes. You should have a better understanding of how your partner feels. You now understand not only that impotence is physically and emotionally complicated, but also that it is usually treatable, often using a drug like Cialis.

To talk or not to talk

You now need to help and understand your partner in this period of his life. He already has considerable worry and anxiety about his inability to perform consistently (or at all). If you come over as confrontational, he will retreat even further into his shell. So you need to think about him as a person.

• Is there a “best” way to raise this issue with alarming him?
• Which ways do you prefer in your battle with ED?
• If you can sacrifice something to win this battle, and what can you sacrifice?

Whatever the approach you devise, should help to relieve the stress he is feeling and to build a spirit of co-operation between the two of you.

So many treatments for cancer and other serious conditions are effective because they are an early intervention. So many men find that more drastic measures are required because they delayed seeking diagnosis until it was almost or actually too late.

Support

Talking about the risks of not seeing a doctor may separate the emotional overtones from the physical issues. We think you still love him even though he is having sexual problems and you do not want to lose him to a disease. Even if the worst should be confirmed, the quality of your relationship during the difficult days of treatment will be far better. Ignoring the problem will only lead to you feeling guilty because you failed to take action and resentment from him that his problems were undiagnosed. Supporting each other openly and honestly is always the best foundation for a relationship.

Talking positively

Talking positively means not to fall into the katatonic state. Rather than focusing on all the things that may be wrong, concentrate on taking early action to restore good health, which if everything else is all right, may just be the simple decision to buy Cialis. By giving him encouragement, you stand a better chance of being able to work together to solve the problems as they come along. If all you do is to hold up a mirror to his negative feelings, you will both lose out.

This is an emotional minefield for both of you so approach it with care and a commitment to be patient even if his first response if very defensive and dismissive. By whatever means it takes, you need to manoeuvre him towards your family doctor and access to diagnostic services and treatment. This may be the usual case that can be treated with Cialis. You will both be reassured and can begin to restore your mutual confidence in sexual activity. If there are more serious problems of blood circulation or nerve damage, work can begin to address the problems. If the cause is more psychological than physical, counselling may be a useful first step for both of you to take.

The problem with writing articles is that it forces you to take a small piece of something complicated and say a little about it. This is a fascinating historical survey of cultural attitudes towards impotence through the ages. It starts with the Greeks and Romans and slowly works its way up to modern times. To some extent, it retreads the same ground as the History of Sexuality by Michel Foucault (in three volumes) but without the same depth of philosophical postmodernism to inform it. Some readers may prefer McLaren because he is more descriptive than analytical.

The difficulty for men can be stated simply. Rather than being judged by their ability to write a book, men are conditioned to judge themselves by their ability to have penetrative sex. If this fails, men are told that there is some shameful defect in their masculinity. Most respond by casting around to find someone else to blame. The conventional response is that women have failed to excite them. So, for example, the mythology of witches in Europe and the early American settlements was based, in part, on the proposition that spells can rob men of their virility.

This simplistic view of gender, distinguishing purely between the functioning male and female, ignores all the shades of sexuality that may manifest in bisexuality, homosexuality, transgender behaviour, etc. By defining maleness by a single criterion of physical performance, it marginalises all the other factors of affection, love and commitment which may affect sexual desire. Worse, it overlooks all the treatable physical conditions that may cause impotence.

As McLaren takes us through history, we see every excuse for failure come into and pass out of fashion. More distressingly, we are told of all the treatments sold by the medical profession over the centuries, many of which are extraordinary by modern standards. Now instead of all the guesswork of the past, we are offered the “truth”. This is ed - a plumbing problem that can be solved by taking cialis. Look around and you will see the hard sell of adverts (pun intended) for these pills. Yet, the implication of these adverts is no more true than Freudian notions that performance weakens when childhood memories interfere with adult lives. Although cialis does effectively restore erectile function, it is a “magic” fig leaf to cover the lack of understanding about the real causes of the problem.

More realistically, McLaren argues that impotence is not really a medical disorder to be treated. It is more a collection of concepts and ideas that have been used to define gender roles and expectations. If we take the word “orgasm” and try to explain what it means, we are immediately lost in a world of subjective impressions. It is always easy to fall back on physical explanations of the mechanics of arousal and consummation. But actually listing the main sensations and emotions in a way that captures their universal significance is a serious challenge. Then trying to place the definition in a context of social relationships, some acceptable, others less so, turns the entire exercise into a minefield of taboo issues.

The book is a highly informative study of social attitudes through the ages. Having read it, it would not be unfair to conclude that our attitudes today are little different to those that defined men in Ancient Rome and Greece. The only difference, I suppose, is that rather than having to eat something disgusting or soak your penis in something potentially dangerous, we can now simply take cialis while reading the last few pages of the book and then be ready to enjoy sexual activity for the rest of the night without having to work about philosophical niceties.