How do I know if I'm addicted to pornography?

The following questions are excerpted and adapted from Hope and Recovery-A Twelve Step Guide for Healing From Compulsive Sexual Behavior. These questions do not constitute a standardized test designed to diagnose addiction. Those who answer yes to many of these questions will find that they have common experiences with pornography addicts. It is the hope of the authors of these questions that those who answer "Yes" to any of these questions will carefully consider the effects their sexual thoughts and behaviors have on their lives today. Those who do have concerns about their sexual thoughts and behaviors need to know that they can get help and support.

Yes ---- No

For some, Valentine's Day is an important reminder to romance your loved one. But February 14, which is also National Condom Day, should also serve as reminder of the importance of protecting yourself and your partner from sexually transmitted disease (STD).

According to the American Social Health Organization, there are an estimated 15.3 million cases of STDs diagnosed every year in the United States. And many of these men and women don't know that they have an STD. As a result, people- especially those in committed relationships- tend to underestimate their risk of transmitting or acquiring an STD and are often lax about condom use. By developing a sense of "negotiated safety," couples often come to the unfounded conclusion that they are not putting each other at risk for an STD.

Other couples avoid discussing condom use until they're just about to have sex-and are less likely to make a reasonable decision. And still others use condoms incorrectly, sometimes making sex less enjoyable and the condom less effective.

Below, Richard Crosby, PhD, of the College of Public Health at the University of Kentucky in Lexington, discusses common barriers to condom use and why couples need to make decisions about condom use together.

Are more people using condoms today than they were 10 years ago? There have been some increases and some general trends towards stability, with very little evidence of decline. We have some evidence that condom use among adolescents increased substantially in the 1990s and is now relatively stable. But among young gay men evidence suggests the possibility of decreases in condom use. These are men who have always known AIDS, and who, in a sense, may have accepted AIDS as a normal part of gay life. And it's these men who we're particularly worried about in public health.

What are the main factors that influence use? I think the answer is really a function of whom we're talking about. The factors that influence use for adolescents are going to be quite different than those that influence use for adults. Among adolescents, factors like peer norms are important. For example, adolescents who have friends who use condoms are more likely to use condoms themselves. And there's also evidence suggesting that once pregnancy concerns are addressed with oral contraception, for example, condoms may no longer be used.

In adults, a lot of factors have been studied, and probably one of the most commonly reported findings is adults in steady relationships are far less likely to use condoms than those who are having sex within non-steady relationships.

Why are committed couples less likely to use condoms?

Trust may be part of it. Some couples will eventually get to a point where there is some mutual testing for HIV or STDs. But couples may be more likely to develop a sense of negotiated safety, where they may make some agreement not to have sex with others and they may in a sense make some unfounded judgments about the other person's risk of transmitting an STD or HIV. There's also some evidence that at some point people in a steady relationship subsequently decide to abandon condom use altogether. Although the evidence is not definitive, their thinking may be: "If we were going to have a problem as a result of having unprotected sex, that problem would have occurred by now." That's an unfounded judgment as well.

Is forgoing condom use actually discussed? We have evidence showing that some of that negotiated safety is something that partners discuss and the decision is a mutually agreed-upon decision by the couple. In other cases, though, the decision may be unilateral. It may be a decision that is made by a female or a male partner. In many cases, the evidence suggests that male partners make this decision more often than female partners. This form of unilateral decision-making is clearly problematic if the male partner is unconcerned about transmitting HIV, STDs or causing a pregnancy.

Why don't people like using condoms? Lack of pleasure and irritation caused by condoms are very common. But because people often have very little instruction on the correct use of condoms at all, they wind up experiencing problems related to fit, irritation, and dryness. I want to add that the correct use of condoms and lubrication for condoms can dramatically diminish those pleasure barriers.

Lack of arousal, sensation, and enjoyment in the female partner are some reasons why people don't use condoms during sex

In many cases, men report losing erections prematurely as a consequence of this feeling that "I am not experiencing the sensation of sex," because the condom has become dry. That may also cause lack of arousal, sensation, and enjoyment in the female partner. I think it's important to always purchase lubricated condoms. But for many couples, the amount of lubrication that is provided with condoms when they're sold in a package is not enough, and they may need to add lubrication at some point during sexual intercourse.

Dry condoms can lead to increased friction, which may facilitate the process of the latex breaking down and the condom breaking. Dry condoms can also potentially cause slippage of the condom (perhaps to the point of falling off) during intercourse. Importantly, couples also need to know that only water-based lubricants can be used on condoms because oil-based lubricants will deteriorate latex and grossly compromise any protective value of the condom.

Access is also an issue that deserves some attention. There are some studies suggesting that although cost may not be a primary issue relative to using condoms, general access may be. For example, it may be that people simply are not prepared for sex in terms of having a condom available. And obtaining a condom after the sexual interlude has begun may be something that just doesn't happen.

Do you think most people underestimate their risk of STDs and HIV? There are some studies that show it's not unusual at all for people to underestimate their risk of acquiring an STD or HIV. There is something that has been termed optimism bias, which suggests that people inherently feel that they are somehow protected against maladies as compared to their peers who are like them and who may practice the same forms of risky sex. It's important for couples to realize that regardless of perceptions that one another may be healthy, the vast majority of sexually transmitted infections are asymptomatic, meaning that symptoms, if they're present at all, may not be noticeable to the person. It's not like having a cold. And in many cases, the symptoms may not even be noticeable clinically.

Is it known if people are getting tested for STDs and HIV? The Centers for Disease Control and Prevention estimates that approximately one-third of United States residents currently infected by HIV are unaware of their status, so the lack of HIV testing is an important public health concern. Unlike HIV, however, testing for STDs has not been a "stand alone" health behavior. Instead, people are often tested for STDs only when they experience an otherwise unexplained symptom. An exception of great importance is that testing for HIV and STDs in the first trimester of pregnancy has become a common practice in the United States.

What are some common mistakes people make when they use condoms? One of the most common mistakes that couples make when it comes to using condoms is they fail to use the condom from start to finish of penetrative sex. There's a perception that it's only the moment of ejaculation that creates risk, so what couples will do is use the condom only long enough to catch, if you will, the ejaculation. But before and after ejaculation occurs, there is potential for infectivity.

Other examples would be using condoms that are not stored properly or that for any reason have been damaged. Couples who use condoms correctly should store the condoms in a cool, dry place. They should make sure the condom is not damaged in any way, whether that's a puncture hole through the package or even opening the package incorrectly. Teeth, sharp fingernails, scissors and other objects should never come near a condom.

I again want to provide a caveat here that I think is critical, and that is the most common error of all errors is not using a condom at all.

When do you think couples should talk about condom use? It's critical for couples to have that discussion before they become sexually aroused. When couples have already entered a stage of foreplay, it's much more difficult for most people to really slow down and talk about something as seemingly mundane as the prevention of disease.

This discussion about disease is, in fact, antithetical to the whole scenario of love, romance, trust, intimacy. And so certainly, having the discussion during the sexual interlude or preceding the sexual interlude is highly problematic.

Do you have any advice about how people can best broach the subject? Unfortunately, we really have very little research to suggest that one approach is better than another. I can only suggest that couples entering the conversation in the spirit of mutual decision-making are going to be way ahead compared to couples where one person is making the sexual decisions.

Schizoaffective disorder is, like schizophrenia, a psychotic disorder. In addition to psychotic features, schizoaffective disorder has significant mood symptoms. This rare mental illness is related to both schizophrenia and bipolar disorder or major depressive disorder and affects approximately one-third fewer people than schizophrenia.

To receive a schizoaffective disorder diagnosis, someone must meet all the primary criteria for schizophrenia and have prominent mood disorder symptoms as well. This basic description of this disorder is accurate, but it falls a bit short. Let’s take a deeper look to answer the question: What is schizoaffective disorder?

Schizoaffective Disorder DSM-5

The American Psychiatric Association explains schizoaffective disorder in the DSM-5, the book that is the accepted authority on mental illness and personality disorders. Someone with schizoaffective disorder meets the primary criteria (Criterion A) for schizophrenia, which includes two or more of the following:

• Delusions
• Hallucinations
• Disorganized speech (speech that is easily derailed or is incoherent)
• Grossly disorganized or catatonic behavior
• Negative symptoms (flat expressions, loss of pleasure/anhedonia, lack of motivation/avolition, and other experiences that are “taken away” from the person)

Schizoaffective disorder includes at least two of the above symptoms related to psychotic disorders and these DSM-5 criteria:

• A major mood episode (either major depression or mania) that lasts for an uninterrupted period of time
• Delusions or hallucinations for two or more consecutive weeks without mood symptoms sometime during the life of the illness
• Mood symptoms are present for the majority of the illness
• The symptoms aren’t caused by substance use

(More on schizoaffective disorder symptoms here.)

Schizoaffective Disorder: Psychotic Features, Mood Features

When someone is experiencing both psychotic and mood symptoms, it can be difficult to determine what he or she is truly experiencing. Schizophrenia, schizoaffective disorder, and bipolar disorder all can involve

• Feelings of elation for an extended period
• Rapid speech
• Racing thoughts
• Bizarre behavior
• Risk-taking behaviors
• Agitation
• Grandiose delusions
• Hallucinations

If someone is experiencing such a mix of symptoms, what’s going on? Is it a psychotic disorder with mood features, or is it a mood disorder with psychotic features? Both types of schizoaffective disorder diagnoses exist, and it often takes time for professionals and family members to help someone sort out what she’s experiencing.

Professionals gather evidence and look for patterns of symptoms and behaviors. If someone’s dominant symptoms are mood symptoms but he experiences some periods of psychotic features, he most likely has a mood disorder with psychotic features.

If, however, someone experiences both psychotic and mood symptoms but has at least one two-week period during which she only has psychotic symptoms—mood symptoms aren’t present—then the likelihood is that she has schizoaffective disorder.

The difference between schizoaffective disorder and a mood disorder such as bipolar disorder is subtle, but the DSM-5 delineates the criteria for each, thus helping doctors make the right diagnosis (and thus get the correct schizoaffective disorder treatment). What about the difference among the psychotic disorders? Is schizoaffective disorder the same as schizophrenia?

Schizoaffective Disorder vs. Schizophrenia

Both psychotic disorders share the same primary criteria, listed above as schizophrenia’s criterion A. Schizoaffective disorder involves the addition of mood symptoms. Here’s where it can become confusing: Many of the negative symptoms of schizophrenia, as well as the disorganized behavior and speech, resemble mood-related symptoms.

Could schizophrenia and schizoaffective disorder really be the same diagnosis with a slightly different manifestation in each person? The official answer is no, they are not the same diagnosis.

The DSM-5 includes each of these disorders and gives them their own place within the same section. Several characteristics highlight why each disorder is unique and stands on its own. These features point to schizoaffective disorder:

• Mood symptoms are present for most of the illness
• Social dysfunction isn’t as pronounced as it is in schizophrenia
• Negative symptoms such as the inability to perform self-care aren’t as severe as they are in schizophrenia
• It’s possible to have autism spectrum disorder or another developmental disorder starting in childhood (schizophrenia isn’t diagnosed if such disorders are present, but schizoaffective disorder can be)

Schizoaffective disorder is a psychotic disorder with significant mood features. Like any other mental illness, schizoaffective disorder is highly individualized, so while the standard criteria must be met for a diagnosis, each person manifests those criteria differently.

The prognosis for those living with schizoaffective disorder is mixed. Some people living with schizoaffective disorder function fairly well, while others have symptoms that are more severe and life-limiting. Each person with this disorder has both psychotic and mood symptoms, but everyone has them in different proportions.

Diagnosing schizoaffective disorder can be challenging, but it’s not impossible thanks to the criteria established in the DSM-5. The more accurate someone’s diagnosis, the more specific the treatment plan will be. The right diagnosis means that schizoaffective disorder can be better managed, giving someone a better quality of life.

article references

I recently had the unpleasant experience of turning thirty much to my chagrin. However, I will forever allege that this was not my fault. Time was moving much too swiftly and although I tried my best to stay in the sexy and swinging twenties, I lost my grip and fell flat on my face in my thirties. I am led to believe that I will not be allowed to return. The horror. The horror.

Aside from my momentary lapses of self-pity, there are some great benefits to being a woman in her thirties. As you probably guessed from the title of this article, I am now in my sexual prime. It seems like a cruel joke. Guys can't think about anything but the tent pole in their pants while in their teens and early twenties. But by the time women get to the same stage, the men are calling in reinforcements. I am sure you have all heard about this before. Women hit their sexual prime at thirty......or do they? I almost half expected to become some raging ball of hormones as if I was pushed on by a button when I turned thirty. I was looking forward to it. To my dismay, no such transformation has occurred.

Shedding light on this curiosity of mine was Dr. Sandor Gardos, a doctor in sexual education. According to Dr. Gardos, the notion that women hit their sexual peak at 30 is very misleading. You will find many websites and articles on the very subject talking about how women get their groove on and peak at 30, or 35 while others say 40. But if you are talking about a hormone flux, this is simply not true. Men and women develop the same hormones at the same time: puberty. The only reason why women seem so much more interested at a later age is that we were taught NOT to be interested in sex when we were kids. If you experimented with sex as the boys did, you would be labeled the town Jezebel. Only when women mature are they able to feel more comfortable talking about and practicing sex. They finally open up and begin to feel normal about desiring sex.

Then it becomes a whole new world for women. The reason why people argue about the age of the sexual peak in women is that it varies for each woman. It might take some women, for example, longer to learn how to orgasm. But when each woman finally feels comfortable with her body and the virtues of sex, it just might be like hitting puberty for her, especially if she had always lived a reserved or conservative life. This can be a great time in a woman's life; a true sexual awakening. And if you measure a sexual peak by interest level, then you can say that she has hit her prime. On the other hand, there are some women who go wild and crazy in their twenties and never give a thought to those societal messages, i.e. "Good Girls Don't". All things considered, these girls may not experience this sudden surge of sexual prowess at the 35-year mark. They have already experienced it all. Ahem. But not me, of course. I am an angel.

If there are any young guys out there who are tempted to seduce an older woman just because she may be in her sexual prime and easily lured by an open invitation, you may want to think again. However, it may interest all men and women to know that according to a recent publication in the Oxford Journals, women do experience a subtle phase of heat on a monthly schedule. Mid-month on her cycle to be exact. During this time, women are shown to be more attracted to androstenone (a pheromone-like sweat substance), are more attracted to symmetrical and masculine faces and more attracted to the subject of sex. Even as basic as this is, it's still fun to talk about. In the same journal, I also uncovered a freaky fun fact. The word for heat, Estrus, comes from a Greek word 'oistrus' which means Gadfly. Literally, it means 'in a frenzied state' because when the gadflies would buzz around cattle, they would drive the cattle into a frenzied state which resembled the same state they go into when they wanted to mate. So when scientists refer to estrus in a female, remember that this concept originated from cows.

The Advice Diva has written three self-help guides on relationships and dating which can be found at http://www.advicediva.com. The Diva does not claim to be an expert in any field. However, she has the ability to understand relationships through past experience and her incredible insight.

Doctors can help women enjoy intimacy as they age

One-third of women over 50 struggle with some kind of sexual problem, but most can improve their love lives by focusing on the problem and making some changes, doctors report.

"Many women have talked themselves out of sex after menopause," said Dr. Gail Saltz, a New York City psychiatrist, by convincing themselves their marriage is fine without it, or they're simply not interested in sex anymore.

"But sex is good for you -- it reduces stress, improves sleep, is a good form of exercise, fights aging both physically and psychologically, and enhances the bond with your partner," she said.

Saltz made her remarks Oct. 21 at the annual Women's Health Symposium in New York City. She was one of four doctors at the conference who spoke on stress, the physical and emotional issues that affect a woman's sex drive as she ages, and research into men's and women's brain functions.

There are many physical reasons why women suffer from sexual dysfunction as they age, said Lauri J. Romanzi, a clinical associate professor of obstetrics and gynecology at Weill Cornell Medical College in New York City.

"Motivation is gone, and the ability to be aroused is reduced," she said, which can be due to any number of physical changes that happen to women..

Reduction of hormone levels, which begins at age 35 to 40 and increases significantly around menopause, may lower a woman's interest in sex, as well as cause a decrease in physical sensation in the vaginal area. Weak pelvic muscles can also affect how an older woman experiences orgasm, as can a prolapsed uterus or a dropped bladder -- often the result of childbearing. And worry about urinary incontinence also could prevent a woman from enjoying sex, the speakers noted.

Certain medications -- including those that treat blood pressure, ulcers, depression, even birth control pills -- can also lower a woman's interest in sex, Romanzi and Saltz said.

Equally important is what's on your mind, said Saltz, an associate professor of psychiatry at Weill Cornell Medical College.

"Psychological issues are most often the major contributing factor to sexual dysfunction," she said. "When you're over 50, you could be raising teenagers, dealing with aging parents, facing an empty nest or retirement, or dealing with health problems that begin to crop up. All of these problems can get into bed with you.";

Women at this age may also worry their body doesn't look as good as it did when they were younger, or feel they're less feminine because they've gone through menopause. This can lead them to avoid sex with their partners because they're afraid of rejection, Saltz said.

Then, there can be problems between a woman and her partner -- "If you're angry with your husband, you don't want to have sex," she said.

Fortunately, there are many answers for women today.

"Until about five years ago, sexual dysfunction was only about pain," Romanzi said, but now there's more emphasis on helping women to stay active sexually as they age.

Topical creams, vaginal tablets and hormone supplements -- including a new testosterone patch, which will be available in 2005 -- can improve a woman's sex drive, although such medications need to be carefully monitored by a doctor, Romanzi said.

She also said, "Kegel exercises are the big, secret boon to sex." By strengthening these muscles, which your doctor can teach you to do, you strengthen vaginal muscles, and that can improve how you experience an orgasm.

Doctors can treat other physical symptoms, such as prolapses and urinary and bowel control functions, so a woman can improve her sexual response.

On an emotional level, Saltz recommended first of all "prioritizing intimacy."

"You have to be willing to put it at the top of your list," she said..

She also suggested that women not be shy about indulging in sexual fantasies; be willing to try new things with your partner, and masturbate so you know what gives you pleasure. And talk to your partner about your fears, Saltz said.

"Only action brings change," Saltz added. "Change a little thing to make you feel differently. If you and your husband have a glass of orange juice every morning, put a little umbrella in it and have a mimosa."

The conference was presented by New York Weill Cornell Medical Center, Weill Cornell Medical College and New York-Presbyterian Hospital, all in New York City.

Detailed info on sexual problems facing older adults, seniors, and how to maintain sexual health, intimacy and sexuality in mid-life.

Today's older adults are active, on the go and still doing many of the things they enjoyed in their younger years. 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.

Though movies and television might tell you that sex is only for younger adults, that isn't true. The need for intimacy is ageless. You'll never outgrow your need for affection, emotional closeness and intimate love. Most people still have sexual fantasies and desires well into their 80s and 90s.

It's true that sex won't be the same as it was in your 20s, but that doesn't mean it can't be as fulfilling or as enjoyable. Understanding the changes your body or your partner's body is going through can help you prepare for some of the challenges you'll face.

Natural changes as you age

As you know, your body changes as you age, and these changes can affect your sexual relationships. Although your body's physical changes are the most often discussed, psychological issues factor in, too.

Physical changes

Testosterone regulates your sex drive whether you're a man or a woman. And most aging men and women produce enough testosterone to maintain their interest in sex. Although your body will go through changes that may make some aspects of sex more difficult as you age, these changes give you reason to try new positions and techniques.Men and women experience different changes in their bodies as they age:

• Women. Most physical changes in your body are linked to menopause and reduced estrogen levels. As you age, it takes longer for your vagina to swell and lubricate when you're sexually aroused. Your vagina also loses elasticity. Together these can make intercourse less comfortable or even painful. You might also feel a burning sensation during intercourse or discover vaginal bleeding afterward.

• Longer foreplay sometimes helps stimulate your natural lubrication. You can try a water-based lubricant, such as K-Y jelly, or talk to your doctor about estrogen cream or estrogen replacement therapy. Having intercourse regularly helps maintain lubrication and elasticity. If you haven't had intercourse for a while, it will take time to stretch out your vagina so that it can accommodate a penis. Talk to your partner about taking it slowly to minimize your pain.

• Men. As you age, it might take you longer to achieve an erection. Your erections may be less firm and may not last as long. Aging also increases the time between possible ejaculations. Trying different positions may make inserting your penis easier for you and your partner.

• Talk to you doctor if you're having problems maintaining an erection or reaching orgasm. He or she can help you adapt to these changes. Your doctor can discuss medications that can help you achieve and maintain an erection. In some cases, your doctor might suggest other ways, such as penile vacuum pumps or vascular surgery.

Psychological changes

Maintaining your ability to have sex as you age depends on your mind as much as your body. If you're embarrassed or ashamed of your sexual needs as an older adult, your anxiety can affect your ability to become aroused.

Changes in your appearance might also affect your emotional ability to connect. As you notice more wrinkles and gray hairs, you might feel less attractive. A poor body image reduces your sex drive because you don't feel worthy of sexual attention from your partner.

The stress of worrying too much about how you will perform can trigger impotence in men or a lack of sexual arousal in women. Taking things slowly can help you avoid this pressure.

Talk to you partner about your anxiety. He or she can offer reassurance.

Changes due to medications and surgery

Some medical problems can interfere with how you respond sexually to another person. Chronic pain or surgery and illness that cause fatigue can make sexual activities more challenging or painful.

Some commonly used medications can interfere with sexual function. Drugs that control high blood pressure can reduce desire and impair erection in men and lubrication in women. Antihistamines, antidepressants and acid-blocking drugs can have side effects that affect sexual function.

Talk to your doctor about how your medications and conditions will affect your sexual abilities and how you can minimize those effects.

Improving sex as you age

Many older adults say their sex lives improve as they age. Yours can, too. Improving your sex life requires more communication with your partner and small changes both of you can make.

• Expand your definition of sex. Sex is more than intercourse. As you age, other options might be more comfortable and more fulfilling. Touch can be a good alternative to intercourse. It can simply mean holding each other. It can also mean sensual massage, masturbation or oral sex.

• Communicate with your partner. Communication brings you and your partner closer together. Discuss the changes you're going through and what your partner can do to accommodate you during sex. Maybe a different position makes intercourse easier for you, or other sexual activities, such as massage or cuddling, might interest you. Ask your partner about his or her needs and ways that you can also be accommodating. Communication itself can be arousing.

• Make changes to your routine. Simple changes can improve your sex life. Change the time of day when you have sex to a time when you have the most energy. Try the morning - when you are refreshed from a good night's sleep - rather than at the end of a long day. Because it might take longer for you to become aroused, take more time to set the stage for romance, such as a romantic dinner or an evening of dancing. Try a new sexual position rather than the standard missionary position. You might find one that's more comfortable for you and your partner.

• Manage your expectations. If you didn't have sex very often as a younger adult, don't expect to have lots of sex as an older adult. Maybe you and your partner expressed your intimacy in other ways when you were younger - perhaps you preferred great conversation. If that's so, you'll most likely continue those activities as you age. Partners who enjoy frequent sex when they're younger are more likely to continue that as they age.

• Take care of yourself. A healthy diet and regular exercise keep your body finely tuned. This will keep you ready for sex at any age. Eat a balanced diet with plenty of fruits and vegetables. Exercise for at least 30 minutes a day, most days of the week. Avoid alcohol, as excessive use decreases sexual function in both men and women. Illegal drugs such as marijuana and cocaine impair sexual function, also.

Single seniors can have sex, too

A little less than half of the people 65 and older in the United States are single. If you're single, a new romance can be exciting and may lead to sexual intimacy. Women live longer than men do, so looking for a partner later in life can be frustrating. Meet new people by going to places where other older adults go, such as local senior centers, or by participating in activities other seniors do, such as adult education courses or mall walking. It's never too late to start a new relationship.

If you have a new partner, remember to practice safe sex. Many older adults don't do this because they think they aren't at risk of sexually transmitted diseases (STDs), including AIDS. Contrary to popular belief, AIDS is not a young person's disease. People over 50 make up about 10 percent of AIDS cases in the United States. All sexually active people - no matter what age - can contract STDs. Stay monogamous with your partner or practice safe sex by using condoms. Talk with a new partner about being tested for HIV. Older adults are less likely than are younger adults to have ever been tested.

Talk to your doctor

You might be embarrassed to discuss sex with your doctor. But conversations with your doctor can help you understand the changes your body goes through as you age and how these changes affect your sexual activity.

Q: YOU SUSPECT YOUR 16-YEAR-OLD IS HAVING SEX. WHAT SHOULD YOU SAY OR DO?

Matti Gershenfeld, Ph.D. President, Couples Learning Center Philadelphia, PA

A: I think the first thing you need to do is ask yourself what is the evidence? Have you found your child necking? Has your daughter come to you asking about your gynecologist? A boyfriend, girlfriend, or your child asking you questions about sex is not enough evidence for you as the parent to be questioning your child.

If you do have enough evidence to believe your child is sexually active, there are a few rules to remember: Look your child directly in the eyes and talk, do not scream at them. If you are embarrassed to talk about sex, practice in front of a mirror first. One of the worst things you can do is tell them you can't handle the situation.

This may be the time to talk about real choices--such as what type of birth control they are going to use. It is also fine to let them know you are not pleased with their decision to have sex and encourage them to wait. Chances are that a child who is having sex at 16 is probably going to end up getting hurt.

Timothy J. Hollis Santa Fe, NM

Sixteen is too late! Kids need parents to talk openly and honestly with them from a very young age. This is not a pre-AIDS society that can pretend to be separate from the rest of the world. Kids need to be comfortable with their selves and their sexuality long before they practice it.

Teenagers are the fastest rising risk group for AIDS. We need to confront our own fears about AIDS and stop projecting them on our children. Their lives are at stake.

Children must be lovingly approached and taught the beautiful and ugly sides of human sexuality. They must know the responsibilities that go along with sexual relations before they have children themselves. We all know this is a different world. We must face it with the utmost courage and honesty.

Kathryn Christensen, 16 Apple Valley, MN

I would sit them down and have a nice little heart-to-heart. First, I would talk about physical risks. Then I would talk about emotional risks like where they thought the relationship was going. I'd also talk about birth control because although I'd prefer they wait, it is better to be safe than sorry.

I know kids because I am a kid and I know that, if they want to have sex, they will. But most importantly, I'd let them know I would love them no matter what they do.

P.S. Don't lecture. Lectures are stupid and when they are given, kids usually end up doing the opposite anyway!

Jane M. Johnson, MSW, Planned Parenthood Federation of America New York, NY

I would say that I hoped that it was planned, consensual, non-exploitive, and protected. I would express regret that he/she did not wait until he/she was older, surer, wiser. I would tell him/her that I hoped that now and hereafter his/her love relations are characterized by mutual respect, caring, and kindness...and that they spoke about it and thought about it.

Lawrence Kutner, Ph.D. Clinical Psychologist Harvard Medical School, Cambridge, MA

It's important to talk to children about sexuality--which includes much more than the biology of reproduction--on a regular basis well before they reach adolescence. These discussions should reflect the child's level of maturity and should include issues of responsibility, why we don't force people to do things against their will, contraception, and the prevention of sexually transmitted diseases. This makes it easier for teenagers to talk about their own sexual feelings.

If I suspected my 16-year-old were sexually active, we'd discuss several issues we'd talked about in the past. Are they using condoms and another form of birth control every time? Are either of them feeling exploited or manipulated? What do they want out of the relationship? What will they do in the event of pregnancy? How else might they be able to express their feelings for each other?

Catherine Cavender, Executive Editor Seventeen magazine New York, NY

First off, parents shouldn't hesitate to let their child know their opinion on the subject. You can't control your teenager's behavior, but you have a right to express your thoughts about what he or she is doing. And while your daughter or son may not ask you directly, he or she may need and want your guidance and benefit from your experience. What's key is presenting what you have to say in the right way. You might say, "I'd always hoped you'd wait until you were older and in a caring, committed relationship before you had sex" (if that's how you feel), or "I'd always hoped that you'd be using birth control when you had sex." This approach is particularly appropriate if you're not certain your child actually is having sex. It's non-accusatory and non-confrontational.

If you are sure your child is having sex, whether or not you approve, it's important to get past your own feelings and make sure he or she understands how important it is to be responsible about using birth control and protection from sexually transmitted diseases. While it's disappointing that your child may be doing something against your wishes, it's much sadder to be confronting an unwanted pregnancy or a terminal illness.

Steven O. Philippi Driver, United Parcel Service Valley Stream, NY

If I suspected my 16-year-old were having sex, I would remind him or her that they are responsible for their actions. I would talk to them about the importance of using a condom with another form of birth control to prevent disease and pregnancy. I would also explain that their actions could affect a third person if there is a pregnancy, and ask if they're ready for that.

Last, I would explain that they should not pressure anyone or feel pressured to have sex. And if they had any questions or news to tell, I would let them know I was available.

Handling posttraumatic stress disorder (PTSD) flashbacks can feel impossible at first, but there are techniques to cope with the flashbacks from PTSD, even to the point of stopping them altogether. Of course, therapy and medical treatment for PTSD flashbacks are critical parts of this, but there are PTSD self-help techniques you can use to help deal with PTSD flashbacks too. Flashbacks can decrease in severity and frequency, and some people eliminate them altogether.

Why PTSD Flashbacks Are Hard to Handle

Posttraumatic stress disorder flashbacks can feel very hard to handle because they can pull you out of the present moment to the point where you feel like you’re reliving the trauma. A flashback can create similar levels of stress physically and psychologically as were experienced during the trauma.

How to Handle PTSD Flashbacks When They Happen

It’s important to first realize that flashbacks are not a re-experiencing of the event, but, rather a very vivid memory – something that happened in the past. No matter how real it feels, flashbacks are not trauma happening in the current moment; flashbacks are symptoms of PTSD only.

To help remind yourself that the trauma is past and that you’re safe in the present, changing the verb tense of how you’re thinking or speaking can be helpful. It sounds simplistic but saying, “I was attacked,” rather than, “I’m being attacked,” can actually make a big difference to how a flashback feels.

It is also very important to connect with your body and the current moment when coping with a flashback. This is called grounding.

According to the Manitoba Trauma Information and Education Centre, the following are ways to ground yourself to help deal with PTSD flashbacks:

• Name the experience as a flashback (e.g., this is a memory and not a recurrence of the actual event)
• Use language that categorizes the flashbacks as a memory (e.g., I was attacked, rather than I am being attacked)
• Use the senses to ground yourself in your current environment:
  • Name what you see, feel, hear, smell and taste
  • Rub your hands together
  • Touch, feel the chair that is supporting you
  • Wiggle your toes
  • Remember your favorite color and find three things in the room that are that color
  • Name the date, month, year and season
  • Count backward from 100
  • Use an object as a grounding tool (perhaps something you can carry around with you)

Other coping techniques during a PTSD flashback include:

• Deep breathing
• Recognizing what would make you feel safer (e.g., wrapping yourself in a blanket, going in a room and locking the door, etc.)
• Confide in someone (even though it can be hard to open up)
• Give yourself time to heal
• Peer support (such as a support group for those with PTSD)

Stopping Flashbacks by Identifying Triggers

A trigger is something that can initiate or cause a PTSD flashback. While, initially, it may seem like flashbacks are random, really, triggers do exist and you can help stop flashbacks by identifying your triggers. A trigger can be created by any of the five senses.

According to the Rape and Abuse and Incest National Network (RAINN), to help stop PTSD flashbacks:

• Be aware of your flashback warning signs. There are typically early physical and emotional warning signs before a flashback. This could be a change in mood, pressure on your chest or sudden sweating. Identifying these can help you stop experiencing a full-blown flashback.
• Identify your triggers. A flashback may be caused by a memory, a sensory feeling, a reminder of the event or even something stressful that is not related to the original trauma. Once you determine what these triggers are, you can make a plan to avoid these triggers or better deal with them when they occur.

How to Stop Flashbacks from PTSD Caused by Experiences Like Abuse

It’s important to treat flashbacks and other PTSD symptoms with professional help as if left unaddressed, they can worsen over time. Stopping PTSD flashbacks can occur through professional treatment, typically by a psychologist and a psychiatrist (Treatment of PTSD Flashbacks: Can Anything Help?).

See also:

• PTSD in Rape and Abuse Victims
• Dealing with PTSD from Abuse: What Helps?

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Nothing confuses friendship as much as sex

It is a subject, a question, that often comes up in conversation: Can a man and a woman really be "just friends?" Before you answer this in your own mind, be reminded that there is a significant qualifier here: "just." As in "only" friends. No sex, no lust, no passion, no secret dreams and desires: just friends.

Many would immediately say, "Yes, of course." Others might respond, "No way," while some might feel that yes, such a friendship is a possibility.

A personable, 30-something woman (married with children) has been debating this issue with her 80-year-old father for years. When she goes back home, male and female friends constantly drop by to say hello. Dear dad constantly fusses about her "fooling around." "Dad, I've known these guys since I was a kid," she says, yet again. "We are just friends."

"Ain't no such thing," her dad retorts." A man is always gonna have an ulterior motive."

Some men and women both would agree with this dad's sentiments, though they may rise from his own ingrained sexist attitudes.

A man and woman can indeed be friends, but only after "you get the sex stuff out of the way," a single professional woman tells me.

Yes, that "sex stuff" often gets in the way. How many times have women suggested to a male suitor that they "just be friends"? Sometimes women come to this decision after having sex with the man, thereby confusing him even more. And some men settle for being just friends when in fact they want to be just lovers.

"Sometimes it's a tough balance between friendship and other stuff," says a Southern man who acknowledges close friendships with several women. "Most times I reach a point where I say, 'Well, what do I want to be: a friend or a lover?' I have female friends with whom I've never had sex and never even think about sex. In other friendships, I've considered sex and had to make a decision: Do I really want to screw up this friendship? I've also had lovers who became just friends."

Another guy tells me that most men view all women as potential lovers "at some point and to some degree." And that is not a bad thing, he adds. "You can think about it and move on. You don't have to act on it."

A female acquaintance recently told me how she was pleasantly surprised when an Italian man at her golf club told her: "You are a good friend; I can talk to you about anything. Anything."

Her husband raised his eyebrows, while the man's wife nodded in agreement.

Being curious, I asked: "Just what do you two talk about?"

"Well, recently I advised him to change his hairstyle," she says. "He got it cut short and he looks a hundred percent better. A lot of times we talk about parent-adult children relationships. We talk about some of everything. And believe me, there is no romantic interest. Just talk, just friendship."

The subject of male/female friendships is intriguing and debatable, and everyone seems to have an opinion. What both men and women should keep in mind is, as a young man told me, that true friendship requires shared experiences where trust and loyalty are proven over time. "It's harder for men and women to get to that place, particularly if they become lovers," he says.

When I think about my closest male friends, I find reflections of all sides of the multifaceted issue: A "just friends" settlement. A romance-turned-friendship. Lover as best friend. Male friends who are genuinely just that: friends.

Friendships come in all sizes, shapes and complexities, but nothing confuses this important life relationship as much as sex. A man and woman can indeed be just friends, but friends don't (or shouldn't) express themselves through sex. Simplify your life by learning to separate the two.

Posttraumatic stress disorder (PTSD) flashbacks are examples of a re-experiencing of the trauma that caused the PTSD. Because of this, the details of the flashback tend to be impacted by the person who experienced the trauma as well as the type of trauma he or she experienced. What can be said for what happens during most PTSD flashbacks is that it is scary for those experiencing it and even for those around them.

What PTSD Flashbacks Are Like

Posttraumatic stress disorder flashbacks are like a memory, or part of a memory, that feels like it’s happening right now. So if you have experienced trauma and have PTSD, you may have times when it feels like you are reliving the trauma. This can be very scary as the person having the flashback may not be able to connect with the present moment and may act like the trauma is currently occurring.

According to one person with PTSD:

“I feel like I’m straddling a timeline where the past is pulling me in one direction and the present another. I see flashes of images and noises burst through, fear comes out of nowhere… my heart races and my breathing is loud and I no longer know where I am.”

What Happens During a PTSD Flashback?

What happens, specifically, during a PTSD flashback is individual. That said, according to mental health charity Mind, the general things that happen during a PTSD flashback include:

• Seeing full or partial images of the traumatic event
• Noticing any sense that is related to the trauma (such as hearing, smelling or tasting something)
• Feeling physical symptoms that you experienced during the trauma, such as pain or pressure
• Experiencing the emotions that happened during the trauma (this could be almost anything such as fear or even rage)

Flashbacks can last a second, minutes, hours or even longer.

What Does a PTSD Flashback Look Like?

To someone around a person experiencing a flashback, PTSD flashbacks can look strange. This is because the person experiencing the flashback may act like they are currently experiencing a traumatic event. For example, a veteran may “hit the deck” (dive to the floor) when a loud noise is heard as it may create a flashback of when he or she was being shot at. To the person watching this PTSD flashback, it can look random and completely unmotivated. The person experiencing the flashback can look like his or her actions are “crazy”, when this isn’t the case at all. What the person is really doing is experiencing a severe mental illness symptom.

PTSD Flashback Examples

Monika Sudakov of The Mighty, talks about examples of her PTSD flashbacks:

”Sometimes, it’s as crazy as turning around in the middle of dinner and seeing him standing there, which takes my breath away and triggers my freeze instinct. Often, it happens at night while I lie awake, my brain racing with thoughts, unable to shut them off. All of a sudden, it feels like a wave flooding over my body paralyzing me. I instantly am transported back into my child body.”

”I relive, in absolute vivid detail, a particularly horrible experience. Things like the smell of his breath, the steam on his glasses, the blue towel with multi-colored fish hanging on the towel rack, the taste of his saliva, the feeling of his rough hands against my skin, even the exact blue jean skirt and checkered top I’m wearing bunching up against my skin are intensely and painfully felt. All the while, it’s as though I’m trapped by my mind and my body. An endless loop of remembering and feeling.”

One man who once worked as a fire department officer provides this PTSD flashback example:

”When the distress was at its worst, I had three or four flashbacks a day. I would sweat and become very nervous as I remembered the events of 20 years ago. All the smells were there, and I even felt the heat of the fire moving across my face. People who saw me say that I sometimes walked about and mouthed words, but I was completely detached from my surroundings.”

No matter what your PTSD flashback looks like, PTSD flashbacks can and do get better with PTSD treatment for flashbacks, learning how to cope with PTSD flashbacks, and time.

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