M. Marcus. Emmanuel College.

Alternatives to Viagra (sildenafil citrate) for men: If Viagra (sildenafil citrate) is not an option for one reason or another purchase cipro in india, there are other medications that can be tried cipro 750 mg free shipping. Some involve application into the urethra cheap 250mg cipro visa, or injection into the penis. Some men benefit from a vacuum pump device to aid in erection, and others may choose the surgical implantation of a penile prosthesis. If you are considering any of these options, be sure to see a urologist who is expert in this field. Experiment with different positions if pain, strength, or endurance is an issue for you. Some options are:The "spoon position", in which both partners lie on their sides, the woman with her back to the man, is great for intimacy with or without intercourse. The woman on her back and the man at a right angle to her on his side. The person with less strength or endurance on her/his back, with the stronger partner kneeling above. If you are interested in being sexually active, with or without engaging in intercourse, and the above suggestions are not sufficient to help you achieve the level of activity you desire, ask for help. Your primary care doctor, urologist, or gynecologist may be able to help, or may refer you to a sex therapist. Sexuality in your older years is all about breaking down stereotypes, open communication, individual choices, and embarking on a path of wonderful self-discovery. Despite what many people think, older women can lead healthy and active sexual lives. Weill Medical College of Cornell University, New YorkColumbia University, College of Physicians and SurgeonsMount Sinai-New York University Medical CenterMARK POCHAPIN, MD: Hi, thank you for joining us today. Starting with us today are a few of my guest panelists. When we talk about "elderly woman," what are we talking about? DAVID KAUFMAN, MD: I think that really has changed dramatically over the last few decades. I think that probably for the purposes of this discussion, we should really be speaking about the eighth decade of life, if my panelists agree with me there. That is the time when most of the trouble starts in terms of sexual functioning. PATRICIA BLOOM, MD: So you would say any time between 45 and 55. But I will agree with David that our, I guess as all of us approach, we like to push it. But I think you would agree, surveys show that actually the majority of people over the age of 65 are still sexually active. And even when you get into the 80 and above, still about a quarter to a third of elderly, even women and men, have sexual activity. They would never dare to tell their grandchildren or their children that they could sneak away and see a sex therapist. Obviously as someone gets older, there are physical changes that occur in their body. David, what is occurring in a woman from a medical perspective that might make sexual activity different? Bloom takes care of these conditions on a regular basis. Do you actually address these problems with the patient, or do they actually tell you about them? In fact, a big part of what I do is training young physicians. In addition, the actual changes in the vagina and the surrounding tissues are a critical part of what affects older women, but in addition to that are their medical conditions, which can influence either their interest or their ability. We live in such a society that thinks you have to be a svelte, lithe young thing to be sexually active. So there might just be embarrassment about shifts in body composition or having a stomach. Then the situation of having a new partner late in life is a whole new thing that Dagmar probably deals with. I think even younger women have body image problems. And then it gets quadrupled when you get into old age. But the nice thing about old age, remember, that your partner also loses his eyesight. But many of the women prefer to have sex in the dark. Many of their partners, men, are much more visually oriented than women and it becomes a problem. Part of it is learning to love your body the way it looks right now. I think sort of in a crisis oriented society, you could see that happening. So I work a lot with women to make them more comfortable by just practical means. MARK POCHAPIN, MD: How do women come to a sexual therapist? I get referrals from all of you, and I also get referrals from my book/video packet, which is a do-it-yourself video packet for sex therapy. Couples start using it, and then they get stuck somewhere and they call me. And the so-called transference has already taken place. You feel safe when you have a friend who says "I know this person, and they make me feel safe. That begins way back, but seems to become more of an issue as someone gets older. And I have the women stand nude in front of a mirror and look at their bodies and draw pictures, as an artist. They may start with their feet or their fingernails, but they slowly have to grow to love it.

generic cipro 750mg free shipping

As mentioned earlier order cipro 250 mg on-line, this is a temporary concern for many adolescents cheap 750 mg cipro amex. If your daughter has very large breasts buy cipro pills in toronto, it is important that she wear a bra designed especially to provide extra support, often by use of a criss-cross design in the back. If possible, it should be purchased at a department store that has specially trained undergarment fitters. If you need help or more information on any of these topics, there are some great web sites operated by SIECUS (the Sexuality Information and Education Council of the United States) and Planned Parenthood. For the most up-to-date information about emergency contraception, check the Emergency Contraception website at Princeton University. SIECUS provides an excellent bibliography of resources for parents, children, and adolescents. This article has focused mostly on normal and non-gynecological aspects of puberty. In May of 2003, Wal-Mart elected to cease the sale of three popular magazines--Maxim, Stuff, and FHM: For Him Magazine. By banning these three titles, they effectively banned an entire genre of magazines, one that is relatively new to the United States--the lad magazine. Targeted at young men, these magazines are known for being "salacious but not pornographic" and for their "bawdy" humor (Carr, 2003). Given the popularity of the magazines in this new genre, as well as their overtly sexual content, it is possible, even likely, that they may play a role in teaching their young male readers about sex. In the present study, content analysis was used to explore what is being taught. Current theories of sexuality emphasize that sexual behavior is, to a large extent, learned (Conrad & Milburn, 2001; DeBlasio & Benda, 1990; DeLameter, 1987; Levant, 1997). Although certain aspects of sexuality are physiological, the question of what is considered arousing, what behaviors and which partners are appropriate, when and in what contexts sexual behaviors can be carried out, and what are the emotional, social, and psychological meaningsof these various factors are must be learned. Numerous scholars have observed these differences, which seem to emphasize different roles and priorities for men and women in sexual encounters. Men in general seem to hold more permissive attitudes toward sex, to desire a greater variety of sexual partners and behaviors, and to seek sexual sensations more frequently than women do. In addition to information about gender roles, values, and so forth, there is a wide array of factual information pertaining to sex that can have important consequences; this includes topics such as possible unwanted consequences of sex, the prevention of such consequences, sexual disorders such as erectile dysfunction or vaginitis, the prevention and treatment of such disorders, and so on. That such information is vital is reflected in the facts that over one-third of adult women in the United States have a limited or incorrect understanding of how STDs can be contracted and that one in five adults in the United States have genital herpes (Kaiser Family Foundation, 2003). Adolescents and young adults receive information about sex from a number of sources; parents, peers, churches, media sources, and schools all make a contribution. When adolescents or young adults are asked to indicate their first or predominant source of information about sex, many cite peers or friends (Andre, Dietsch, & Cheng, 1991; Andre, Frevert, & Schuchmann, 1989; Ballard & Morris, 1998; Kaiser Family Foundation et al. Other research, drawn from diverse samples and conducted over many years, suggests that for most topics related to sex, however, independent reading is a more important source of information than parents, peers, or schools (Andre et al. Further, these same studies suggest that this is true for both men and women, and for the sexually experienced as well as the less experienced. Though materials used for independent reading certainly vary, magazines are definitely one such source. Researchers who have employed diverse methods have arrived at the conclusion that adolescents and young adults use magazines to gain information about sexual topics including sexual skills and techniques, reproductive issues, sexual health, and alternative sexualities (Bielay & Herold, 1995; Treise & Gotthoffer, 2002), and that they often prefer magazines over other sources of information (Treise & Gotthoffer, 2002). These findings, coupled with those that document independent reading as an important source of information about sex, suggest that magazines may be very important to the development of knowledge about, beliefs about, and attitudes toward sex, especially for young people. There are theoretical reasons to believe that reading magazines to obtain sexual information may have effects on attitudes, beliefs, and behaviors, as well as information-type knowledge. Cultivation theory has long held that exposure to a consistent set of media messages can lead to altered beliefs about the nature of the real world (Gerbner, Gross, Morgan, Signorielli, & Shanahan, 2002). There is little available research that deals with the issue of what effects, if any, independent reading about sex in general, or reading about sex in magazines in particular, has on readers. What is available is largely correlational in nature. There is an association between receiving more sexual education from independent reading and better performance on a test of knowledge about sex (Andre et al. There is also some evidence that receiving more information from independent reading as opposed to other sources may be associated with more sexual experience (Andre et al. In addition, in one study, reading sex manuals and reading Playboy were each associated with beliefs about greater frequency of behaviors including sexual intercourse, oral sex, and erotic dreams, and reading Playboy was associated with beliefs that sex without love, the use of stimulants for sex, and the exchange of sex for favors were relatively more common (Buerkel-Rothfuss & Strouse, 1993). Limited experimental evidence also indicates that viewing nonpornographic sexual images from magazines can lead to greater endorsement of rape-supportive attitudes (Lanis & Covell, 1995; MacKay & Covell, 1997). Given the apparent influence of magazine content and the importance of independent reading in general, and magazines in particular, as sources of sexual information for young people, it is important to understand what messages about sex are contained in the magazines read by young people. Relatively little research is available on this topic, and what is available is largely concerned with magazines targeted at young women. Magazines targeted at adolescent girls, such as Seventeen and YM, have been found to contain conflicting messages about sex; they encourage girls to be sexy, emphasize the importance of romantic relationships, instruct young women on how to please young men, and simultaneously emphasize patience and control (Carpenter, 1998; Durham, 1998; Garner et al. Studies of magazines targeted at adult audiences, both male and female, such as Cosmopolitan, Self, GQ, and Playboy, have demonstrated that their contents treat women as sex objects, both through use of objectifying images (Krassas, Blauwkamp, & Wesselink, 2001) and the written content of articles about relationships (Duran & Prusank, 1997). Further, magazines such as Playboy, despite their ostensible status as "lifestyle magazines," seem to be in a very different category than lifestyle magazines such as Cosmopolitan that are oriented toward women. That includes enjoying sex and intimate relationships. Like adults of all ages, you probably want to continue sharing your life in a fulfilling relationship. A healthy sexual relationship can positively affect all aspects of your life, including your physical health and self-esteem. Most people still have sexual fantasies and desires well into their 80s and 90s. As you know, your body changes as you age, and these changes can affect your sexual relationships. Jokes abound about the rapaciousness of senior females in quest of a male functional enough to engage in it. And my teenage son wrinkles up his nose and says "Eewww! Media coverage of aging baby-boomers and their older cousins would have us believe that seniors are a homogeneous group jumping into bed and "hooking up - with great regularity. In fact, the level of sexual interest and activity among people over the age of 65 is as diverse as the individuals who make up that population. A recent survey of married men and women showed that 87% of married men and 89% of married women in the 60-64 age range are sexually active. Those numbers drop with advancing years, but 29% of men and 25% of women over the age of 80 are still sexually active. So clearly, the older years can be a time of relief that children are no longer lurking in nearby bedrooms, and there is no longer a need to jump up early in the morning for work. For some, older age is a time of freedom to explore sexual expression in ways never before realized. A time to cast away the "shoulds" of earlier years, the societal expectations.

order cipro 500 mg mastercard

Decide what it is and whether you can really trust it with the other person or persons buy cipro 750mg with visa. Keep in mind that some ways of being open are more appropriate and helpful than others buy 1000 mg cipro with mastercard. Both are certainly ways of being open about the anger purchase discount cipro on-line. However, if other people are with you, talking to them about your anger is probably easier for them than ducking from a book you just threw towards them. Finally, the extent to which others are open with you will depend on how open you are with them. Many people discover that as a relationship develops, openness is reciprocated and the relationship becomes more meaningful. When we stay open to learning, new experiences open up for us. How you resolve relationship problems will help determine the quality of your relationship. Here are some excellent suggestions for dealing with relationship issues. Often, this is because people have conflicting expectations, are distracted with other issues, or have difficulty expressing what is on their minds in ways that other people can really hear and understand what is being said. The following information covers ways of enhancing relationships and working with common problems. This does not necessarily mean agreeing with one another all the time. Realistically, no two people will agree on all occasions. Insisting that your partner spend all of his or her time with you, insisting that they give up their friends or that you both hang around only your friends, insisting that you give approval of the clothes they wear, making sure that you make all the decisions about how you spend you time together and where you go when you go out, making them feel guilty when they spend time with their families, making sure you win all the arguments, always insisting that your feelings are the most important... An example might be when want your partner to show love for you by spending free time with you, sharing and being open, paying attention to your concerns and needs. Time spent apart and time spent together is another common relationship concern. You may enjoy time together with your partner and your partner may want some time together with you, but you also may enjoy time alone, or with other friends. Check out with your partner what time alone means and share your feelings about what you need from the relationship in terms of time together. Perhaps you can reach a compromise where you get more time together but leave your partner the freedom to be alone or with others times when it is needed, without your feeling rejected or neglected or thinking of your partner as selfish, inconsiderate, or non-caring. You may wonder how you can have a good relationship with them, or if you want to. They do want to stay in contact with their children. They do want to see them, visit them and have continuing contact with them. However, a problem sometimes arises when these parents forget that their children are separate individuals and that they now have separate lives and that they must make their own decisions. Some family members volunteer a lot of uninvited advice or try to tell you and your partner how to run your lives. One way of handling this is to listen respectfully, let them know that you care about what they think and what they would do, but not make any promises to follow their advice. Just simply listen because they have a need to say it. If they attempt to pressure you into agreeing with them, you must be firm in saying, "I respect your views and ideas. Thanks for letting us know how you might deal with it. It will also be important that you and your partner be in agreement that you will deal with unsolicited advice in this way so you can support one another in the face of what could be some very intense "suggestions. I have to give up all my personal friends unless my partner likes them as well as I do. Neither should it be assumed that your partner will like your personal friends as much as you do, so insisting that your friends should be their friends might not be reasonable. Just as with other areas in a relationship, who you and your partner spend time with together can be negotiated. You can see those friends somewhere else or you can see them at home at a time when your partner is out doing something else. You do not have to give up your friends who mean a great deal to you. Being forced into giving up friends usually leads to resentment. How do you and your partner make decisions about handling money? How are the priorities set about how money is to be earned? How much money goes into savings and for what purposes? How are "big ticket" (tuition, childcare, rent, car payments) items decided on? Does each member of the partnership control her or his own money or is it pooled? Is each partner expected to add to the mutual income? If only one is to work, how is it decided who it will be? If you find that you and your partner have differing expectations, it makes sense that you will have to make time to talk about them after stating your feelings, wishes, and desires and listening carefully to those of your partner. Discussion and cooperation may not provide any magic solutions to difficult financial problems, but knowing you and your partner agree about how to approach the situation will relieve at least some of the stress. This is neither a good nor a bad thing, but it is a fact. What you want from a relationship in the dating stages might be quite different from what you want after you have been together a number of years. Changes in other areas of your life, outside your relationship, will have an impact on what you want and need from the relationship. You need to be sure you and your partner make time to discuss your expectations and negotiate responsibilities. The most important thing is that you need to do a great deal of careful, respectful listening to what each wants, and a lot of careful, clear communication about what each of you wants. Change of any sort tends to be at least a little stressful, yet because it is inevitable, welcoming change as an opportunity to enhance the relationship is more fruitful than trying to keep change from happening. Planning for changes together can lead the relationship into new and exciting places. Be aware of what you and your partner want for yourselves and what you want from the relationship.

Not much can be done about ADHD while the child is subject to extreme mood swings discount 750mg cipro overnight delivery. Useful mood stabilizers include lithium order cipro 1000mg amex, valproate (Depakene) discount 500mg cipro fast delivery, and cacarbamazepinesometimes several drugs will be needed in combination. After mood stabilizers take effect, the child can be treated for ADHD at the same time with stimulants, clonidine, or antidepressants. ADHD Treatment Mainstays Extend from Childhood to Adulthood Supplement to Psychiatric Times. Is Maternal Smoking During Pregnancy a Risk Factor for Attention Deficit Hyperactivity Disorder in Children? A Pharmacological Approach to the Quagmire of Comorbidity in Juvenile Mania. Journal of American Academy of Child & Adolescent Psychiatry. Written by Gayle Zieman, PhD,Detailed information on panic disorder in children and adolescents; including symptoms and treatments and how parents can help their children with anxiety and panic attacks. A child with panic disorder (PD) has sudden attacks of fear or severe anxiety. The fearful attacks happen several times over weeks or months. They may last a few minutes or they may last for hours. The attacks are not caused by fear of a single thing. That is called a phobia, like being scared of dogs or the dark. The attacks are also not caused by a traumatic event, like child abuse or being in a car accident. If caused by trauma, the child may have post-traumatic stress disorder. All children and teens respond fearfully to the scary events of daily life. Their times of fear, however, are usually brief, and they go away without causing major problems. Panic disorder is when the fearful times happen over and over, begin suddenly without a clear cause, and are severe. PD interferes greatly with daily life at school and home. Panic disorder begins most often in the late teenage years into the mid-30s. Often it never goes beyond this, but some children start having the attacks often. A stressful event, like parents divorcing or a move to a new place, may trigger the beginning. But often PD begins with no identified stressful event. It is common for a child to have periods of time with attacks and then go weeks or months with few or none. What causes attacks to stop and return is often unclear. If a parent has panic disorder, children are more likely to have panic disorder, too. However, more than half of those with PD do not have a parent with a history of panic disorder. Children who were often scared when separated from their parents are more likely to develop PD later. Other than being hereditary, the causes of panic disorder are not certain. Children or teens with PD may:be short of breath or feel like they are being smotheredfeel like they are being choked or have trouble swallowingfeel their heart poundingfeel they are going to die or that they are going crazyfeel very helpless to stop the attacks. Along with these main symptoms, children or teens may:be on guard all the time or startle easilyeat very little or become very picky eatershave trouble concentrating due to worryperform below their capabilities in schoolhave frequent headaches or stomachacheshave trouble falling or staying asleep, or have nightmareslose interest in activities they once enjoyedtalk about death, such as saying "I wish I were dead. When this is the case, the child often worries as these times approach. A mental health therapist who specializes in working with children and teens may be best qualified to diagnose PD. Sometimes your child may need lab tests to rule out medical problems causing symptoms like stomachaches, trouble swallowing, or difficulties breathing. Children and teens may have other problems or disorders in addition to PD, such as: Cognitive behavior therapy (CBT) helps children learn what causes them to feel panic and how to control it. CBT teaches specific skills for managing the fear and the worrisome thoughts about whether an attack is coming. Gradual exposure therapy teaches the child to stay relaxed while being exposed to situations associated with panic attacks. Family therapy treats the whole family rather than just the child. Children often feel very supported when parents and siblings attend therapy with them and work as a group. Medicines are sometimes needed when the symptoms are severe. Medicines may help reduce the frequency of attacks or how severe they are. Medicines used to treat PD in adults may not work best for children and young teens. It is important to have an experienced professional working with you and your child. Most children and teens can get over PD with good treatment and family support. Very often PD lasts for weeks or months and then disappears or reduces dramatically. If a child has had PD once, then they are at greater risk for future PD. The mental health professional treating your child may recommend continuing treatment after your child begins to feel better. Symptoms may return since PD often comes and goes without a clear reason for stopping and starting. It is very important to help your children feel supported and reassured. Reassure your children that their feelings are understandable and that they are not "going crazy.