Is It Time for Sex? Things to Think About

Your decision to enter into a sexual relationship with another person can be extremely exciting, difficult, scary, or intense. Like any big, important decision, it is one that requires that you gather and consider a good deal of information beforehand so that is an educated decision. There are many aspects of sexual intimacy to consider.

Personal, Psychological and Spiritual Principles to Ponder

From all directions, there are messages in our society about sexual activity. If you are thinking about entering into any kind of sexual relationship, it is wise to think over the following points (and the rest of the information on this sheet) and figure out what your own beliefs and conclusions are before making the choice.

  • Will my behavior harm me or the other person, physically or psychologically? Will I still like myself? What are all the possible outcomes and/or problems that could arise?
  • Will my behavior help me become a good future spouse or parent? Do I believe that premarital sex is okay? Is this behavior consistent with my personal principles?
  • What do my spiritual values say about this behavior?
    • Am I willing or able to follow the principles of my religion?
    • How will I feel if I don't?
  • Does my sexual expression enhance my self-esteem, self-respect, positive feelings about myself
    • Do I believe this will be enjoyable and gratifying to me?
    • If it isn't, will I continue or not?
  • How will having a sexual relationship with this person affect our relationship beyond sex?
  • What will I do if my partner and I get pregnant?
    • Can I handle having a child?
    • Marriage?
    • An abortion?
    • Putting the baby up for adoption?
  • What precautions will I take to avoid pregnancy and sexually transmitted diseases? What will I do if I or my partner gets a sexually transmitted disease?

What are Sexually Transmitted Diseases (STDs)?

Sexually Transmitted Diseases are infections, some of which can be fatal, that get transmitted from one person to another during unprotected sexual contact. Sexual contact includes a wide variety of activities which are listed on the other side of this sheet. The various STDs include Chlamydia, Human Papillomavirus Infection (HPV) which includes Genital Warts and Condylomas, Herpes, Hepatitis B, Gonorrhea, Syphilis, and Human Immunodeficiency Virus (HIV) which leads to Acquired Immune Deficiency Syndrome (AIDS). There are other brochures in this office and at Health Services that can provide more information about these STDs.

How Can I Protect Myself?

Use latex condoms to prevent the exchanges of semen and vaginal secretions. Be sure you learn the proper way to use a condom before trying it. Used incorrectly, condoms are ineffective at preventing STDs and pregnancy.

Lubricants can prevent discomfort associated with dryness during intercourse, as well as the bruising that happens during anal sex. However, if you choose to use lubricants, always use water-based lubricants such as K-Y Jelly or spermicidal jellies. Oil-based lubricants like Vaseline or most hand or body lotions can weaken condoms and make them break. Lubricants that contain the spermicide nonoxynol-9 also provide extra protection against HIV.

Communicate openly and effectively with your partner before any sexual activity.

Don't mix alcohol or drug use to help you overcome uncomfortable feelings associated with sexual intimacy. You probably would benefit from re-examining your reasons for entering a sexual relationship a this time or with this particular person.


But... What Sexual Contact Is Safe... And What Isn't?

Safer

  • Dry kissing
  • Masturbation on skin with no open sores/cuts
  • Oral sex on a man wearing a condom
  • External watersports (urinating on skin without open sores)
  • Touching, Massaging
  • Sharing fantasies (the brain is the largest, most versatile sex organ)

Less Risky

  • Vaginal intercourse with a condom
  • Wet kissing

Risky

  • Oral sex on a man without a condom
  • Masturbation on open or broken skin
  • Oral sex on a woman
  • Anal intercourse with a condom
  • Engaging in sexual contact after alcohol or drug use
  • Oral sex with dental dam
  • Vaginal sex with female condom

Dangerous

  • Vaginal intercourse without a condom
  • Anal intercourse without a condom
  • Internal watersports (urinating into mouth, vagina or rectum)
  • Sharing a needle for intravenous drug use
  • Fisting (putting hand or fist into someone's rectum or vagina, easily tears skin, allowing germs to enter bloodstream)
  • Rimming (oral to anal contact)

What is Safer Sex?

"Playing it safe" doesn't have to mean eliminating sexual intimacy from your life. It means playing it smart, staying healthy, showing respect for yourself and your partner. Safer sex means talking openly with your partner in order to find out about your partner's health and sexual patterns and to communicate your own. It means discussing what will happen between the two of you and making choices to protect yourselves during sexual activity. It is WHAT you do, not WHO you are, that creates a risk for sexually transmitted diseases.

Got questions?

Contact your doctor, student health office, or local Planned Parenthood office.

APA Reference
Staff, H. (2021, December 23). Is It Time for Sex? Things to Think About, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/relationships/teen-relationships/is-it-time-for-sex-things-to-think-about

Last Updated: March 21, 2022

Choosing a Healthcare Provider for HIV Treatment

Introduction

If you are newly diagnosed with HIV infection, this may be a very difficult time for you. Many newly diagnosed HIV patients have severe bouts of depression and anxiety. They simply don't know where to turn or what they should do. This may lead to denial, procrastination, and avoidance. If you feel like this and have not taken steps to seek treatment, this understandable, but unfortunate behavior may be not only detrimental to your health and well being, but also may deny others the opportunity to be tested and treated or may lead to further spread of HIV through continuation of unsafe sex practices or needle sharing.

The Decisions

There are several decisions you have to make in order to be sure that you are doing what you can to:

  • prevent the spread of HIV
  • prevent the progression of your HIV disease to AIDS
  • avoid getting sick or perhaps even dying

If you are engaging in high-risk behaviors, the first decision you need to make is to stop engaging in these behaviors, as they may endanger others and cause them to become infected. This means that you must not have unprotected sex (a condom or dental dam are required at all times to prevent direct contact) and, if you use intravenous drugs, you must not share needles with other people. The people with whom you have had sex or shared needles in the past may or may not already be infected. You should consider informing them yourself of their exposure to HIV, but if you are unable to do so, you should contact your doctor or the health department so that the people with whom you have had sex or shared needles can be informed anonymously and then get tested. If you have children, they may also need to be tested, but you can discuss this with your doctor as well.

Choosing a Healthcare Provider

This decision involves first assessing your healthcare options, gathering some information about providers, making a choice, and scheduling an appointment. Keep in mind that your contact with the healthcare provider you choose will be confidential and that your provider will not release information about you unless you tell him or her that it is all right. Remember, just because you visit one healthcare provider doesn't mean you have to stay with him or her. If you don't feel comfortable with that provider or you don't like him or her, then you should continue your search and go see another provider. If you are a part of an HMO, you may need to pick a doctor from the list of providers in your HMO or you may be referred to an HIV specialist by a primary-care doctor. Someone at your health plan should be able to provide you with information about how to find an HIV specialist so that you are able to have several choices.

The medical qualifications
Healthcare providers include physicians, physician's assistants, and nurse practitioners. Physicians have been to medical school, followed by a residency in internal medicine or family medicine, and in some cases, a fellowship in a subspecialty such as infectious disease. Nurse practitioners and physician's assistants have not been to medical school nor have they done a residency or fellowship, but they have received a substantial amount of education and training and in some states, they are allowed to treat patients without physician supervision.

Some people feel more comfortable with a doctor, while others feel more comfortable with a nurse practitioner or physician's assistant. You can receive excellent care from any of these healthcare providers so long as he or she is well versed in treating HIV disease and has adequate experience. This is an important attribute to remember, as several studies have shown that physician experience plays a major role in how well a person with HIV disease does, including whether they get sick and how well they take their medications.

Support staff
Also, it is important to keep in mind that when you choose a healthcare provider you are also choosing that person's support staff and system. Since there are a number of social issues and questions associated with HIV disease, you want to make sure that the doctor has someone on staff or someone to whom he or she can easily refer you who can help you take care of insurance and billing issues, drug or alcohol problems, disclosure issues, and other concerns that patients with HIV disease frequently must confront. These issues are complex and frequently require expert assistance from a very knowledgeable person. You are going to have enough to deal with. You should not have to be constantly struggling to get the benefits and help that you need.

Getting the provider you want

Since you are unlikely to know many healthcare providers, one of the biggest questions you might have is, "How do I find the healthcare provider that I want?" You can start by asking relatives and friends, especially those who are HIV infected. If your family and friends do not yet know about your HIV infection, before approaching them, you should consider whether or not you want them to know. If you don't, there are other ways to find a doctor. You can call a local medical society or a local patient advocacy/support group. For example, you could call a Gay Men's Health Crisis center in your area or a methadone maintenance clinic. You could also call a local hospital. They may be able to provide you with a list of the experienced healthcare providers in your area. Additionally, you could ask your current healthcare provider to refer you to an HIV specialist (i.e., someone who treats a significant number of HIV-infected patients).

If you cannot find a provider with adequate experience in your city, consider contacting services in larger cities that may be nearby. Some of my patients travel quite a distance to see me because they could not find anyone locally with whom they were happy and our center provides not only excellent healthcare but also provides them with access to new treatment studies and the support services HIV patients need.


Doing research
Once you have identified a potential healthcare provider, consider calling their office and getting information about:

  • the number of patients they treat
  • the number of years they've been involved with HIV
  • their educational and training background
  • any support staff they can provide for you (e.g., social worker, psychiatrist, nutritionist)

Scheduling an appointment
If you are satisfied with the preliminary information, then schedule an appointment for an initial visit. If not, keep looking. I can assure you that with a little effort you will be able to find an excellent provider who will be able to meet your needs.

The Initial Visit

The initial visit can be frightening and intimidating, but you should keep in mind that the entire purpose of the visit is to provide you with the medical and other help you need to control HIV infection. You may not feel very comfortable during this visit and a lot of things will be happening, but you should try to assess whether you will eventually be comfortable in this setting, receive the support and services you need, and have confidence and trust in your healthcare provider.

The paperwork
Your healthcare provider and his or her staff will guide you through the steps involved in the initial visit. This generally starts with a lot of paperwork, with which the staff can help you. This process will be smoother if you bring any insurance information or past healthcare records you might have with you. It will also help if you are on time or even a little early so that you have plenty of time and do not feel pressured or rushed.

Meeting with the healthcare provider
Usually, after the initial paperwork is completed you will meet your healthcare provider. He or she will often begin the meeting by obtaining a thorough medical history and doing a physical examination. This might include having blood drawn and sent to a laboratory for testing. He or she will provide you with a basic education and information regarding HIV disease, including the basic disease process and treatment options that are available. It is important that you tell your provider about any medical problems you have had in the past and if you are allergic to any medications.

Making a custom-fit treatment plan

You should use this time to discuss your treatment objectives with the provider. Every patient has different goals and ideas about their treatment. You should talk about these with your doctor and make sure that he or she feels comfortable with them and is not using a "cookie-cutter" approach, where every patient must do the same thing (for example, take antiretrovirals). Your doctor should show flexibility and adjust to your needs, while at the same time providing you with the education you need to make informed and knowledgeable decisions.

If you have not previously had a CD4+ lymphocyte and HIV viral load performed, the provider may not be able to provide any specific treatment details at this point, as he or she does not know how the virus has affected your body. Still, the provider should lay out the general approach that will be taken to control your HIV disease and to prevent opportunistic infections. You should feel free to ask questions and, if possible, to get written materials you can take home to read. If you already have strong feeling or beliefs about certain treatment options, you should specifically discuss these with your provider.

During this visit you should feel free to ask the provider any questions you may have about his or her medical background, and if these questions are met with hostility, you should be wary of this doctor. Your relationship with your healthcare provider must be based on trust. You will need to develop a rapport with your provider that allows you to feel confident about his or her medical advice, and feel confident making the important decisions about your own care.

Discussing disclosure
The provider may also take this opportunity to discuss disclosure issues (e.g., telling family members, telling others who might be at risk) and the need for you to seek additional help regarding depression, substance abuse, or other issues which may affect your health and healthcare. Again, this is a chance for you to share, with complete confidentiality, the concerns you have and problems you are experiencing. To have a trusting and supportive relationship with your provider is essential to maintaining your good health and you should take advantage of this rare opportunity to get things off your chest and get the help you need.

Conclusion

Choosing a healthcare provider to help you treat your HIV disease can be an overwhelming decision. However, it is also a very important one. Take the time to research and find the right provider and support staff for you. It will help you as you learn to manage your HIV disease and keep you healthy.

Brian Boyle, MD, JD, is an Attending Physician at the New York Presbyterian Hospital-Weill Cornell Medical Center and Assistant Professor of Medicine in the Department of International Medicine and Infectious Diseases at Weill Medical College of Cornell University.

APA Reference
Staff, H. (2021, December 22). Choosing a Healthcare Provider for HIV Treatment, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/diseases/choosing-a-healthcare-provider-for-hiv-treatment

Last Updated: March 26, 2022

Suicide Information, Resources & Support

Comprehensive information about suicide. What to do if you're feeling suicidal, how to help the suicidal person, why people kill themselves and more. In addition, you’ll find suicide hotline numbers and other resources.

Suicide Hotline Phone Numbers

If you feel suicidal or you're in a crisis situation and need immediate assistance, people at these suicide hotlines in the U.S. are there to help.

  • 988 (1-800-273-8255 will continue to work indefinitely) - National Suicide Prevention Lifeline
  • 1-800-784-2433 (1-800-SUICIDE) - National Hopeline Network
  • 1-866-488-7386 (1-866-4.U.TREVOR aimed at gay and questioning youth)

Information on Suicide Hotlines and Suicide Chat

Suicide Support

Helping Someone Who Is Suicidal

General Information About Suicide

Suicide and Mental Disorders

Youth (Child and Teen) Suicide

Suicide Information for Teens

Teen Suicide Information for Parents

More Teen Suicide Articles for Parents

Therapy for Helping Suicidal Person

After a Suicide

Gay Teen Suicide

Books on Suicide

Suicide Resources

APA Reference
Staff, H. (2021, December 22). Suicide Information, Resources & Support, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/other-info/suicide/suicide-suicidal-thoughts-and-behaviors-toc

Last Updated: September 5, 2022

What Is Tardive Dyskinesia (TD)?

Find out about Tardive Dyskinesia, TD, a major side effect of prolonged treatment with antipsychotic medications used to treat schizophrenia, bipolar disorder, depression.

Find out about Tardive Dyskinesia, TD, a major side effect of prolonged treatment with the antipsychotic medications.

Tardive Dyskinesia (TD), a term coined in 1964, describes a set of abnormal, involuntary movements of the orofacial area or extremities. TD is thought to result from prolonged treatment with the neuroleptic (antipsychotic) medications that help to control symptoms of severe mental illness, particularly schizophrenia. Tardive means "late" and "dyskinesia" means "movement disorder."

What are the symptoms of TD?

The symptoms of Tardive Dyskinesia range from occasional to continuous, and from barely perceptive to blatant. At one extreme are slight movements such as involuntary blinking, lip-licking, tongue-twitching, or foot-tapping - symptoms that may go unnoticed even by the patient, his/her family, or doctor. At the other extreme are conspicuous movements such as writing, rocking, twisting, jerking, flexing, and stiffening of virtually any or all parts of the body. Fortunately, the occurrence of severe cases of TD is relatively rare (about five percent).

How do antipsychotic drugs increase the risk of Tardive Dyskinesia?

Although it is not clear how antipsychotic drugs do what they're supposed to do, much less how they increase the risk of TD, it is know that they change how nerve impulses jump from one set of nerve cells (pre-synaptic neurons) across a gap (synapse) to another set of nerve cells (post-synaptic receptors). The impulses are carried by substances called "neurotransmitters." Anti-psychotic drugs block a particular neurotransmitter called "dopamine," allowing little of it to reach the post-synaptic receptors.

It is assumed (but not proven) that dopamine blockades in various nerve pathways of the brain cause the unwanted effects of antipsychotic drugs, including TD. According to one hypothesis, the dopamine blockade results in the post-synaptic receptors becoming hypersensitive to the little dopamine that does leak through. Constant (and possibly increasing) doses of medications may be needed to keep dopamine from playing havoc with the hypersensitive receptors.

Perhaps no single hypothesis will ever fully explain TD because it may not be a single disorder. Instead, TD may encompass two or more disorders - each with a different cause and treatment. Recent studies suggest that other neurotransmitters such as norepinephrine, serotonin, and GABA may play a role in the development of TD.

To date, it is thought that many available neuroleptic medications cause TD. The relatively new neuroleptic clozapine is thought to not cause TD, and risperidone - another new medication - may not be associated with a major risk. This observation lends considerable hope to the possibility that better antipsychotic agents will be developed.

If antipsychotic drugs can cause TD, why use them?

The research literature provides ample evidence that, for most patients who are seriously and persistently mentally ill, antipsychotic drugs offer reliability, effectiveness, easy access, and few hazards. One study indicates that the relapse rate of acute mental illness in a group staying on antipsychotic drugs in a one-year period is about seven percent to 10 percent. For those going off medication, the recurrence rate is between 70 percent to 80 percent within a year. Newer medications that carry less risk of TD may become more frequently used.

What can patients and their families do about Tardive Dyskinesia?

Maintain frequent contact with a psychiatrist well-trained in the use of antipsychotic drugs. Maintenance dosages should be kept as low as possible and still control symptoms. New research is finding that doses can be reduced if careful attention is paid to "prodromal" or early warning signs of psychosis. These drugs should be discontinued when no longer needed. No one should take these medicines if they are not benefiting from them. Usually, neuroleptic medications are prescribed on a long-term basis for diagnoses of schizophrenia, schizoaffective disorder, depression with psychotic features, bipolar illness, and organic brain syndromes. Certainly, neuroleptics may be prescribed for additional diagnoses, but if they are, it is important to discuss the strategy with the prescribing psychiatrist. Ask the psychiatrist to discuss the "risk-benefit ration" of the particular medication that is prescribed. Be alert to the symptoms of TD as described in this pamphlet. Promptly call them to the attention of your doctor. Support studies of TD and newer neuroleptic medications.

How common is TD?

Long-term studies have determined that TD develops in 15 percent to 20 percent of the patients taking antipsychotic drugs for several years. In the United States, where there are about two million people afflicted with schizophrenia, that means there are at least 300,000 people with TD. Recent studies indicated that the average yearly incidence rate (new cases) ranges from .04 to .08 a year. We see a relatively constant rate of new cases during at least the first seven years of treatment with neuroleptics. It is still unclear if this rate continues to climb after this period of exposure.

Can patients at risk for developing TD be identified?

The risk of developing TD appears to be highest among elderly, chronically ill patients who have taken the drugs for the longest periods. That is all that is known at this time.

Is anyone doing research on TD?

Because of the increasing magnitude of the problem, much research is underway. For example, the National Institute of Mental Health has given a research team at Yale University almost $1 million to find ways to decrease the major side effects of antipsychotic drugs. These researchers are developing alternative treatments, studying risk factors, and experimenting with lowered drug doses to find the point at which side effects disappear but the drugs are still effective.

APA Reference
Tracy, N. (2021, December 22). What Is Tardive Dyskinesia (TD)?, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/thought-disorders/schizophrenia-treatment/what-is-tardive-dyskinesia-td

Last Updated: March 25, 2022

Surgical Management of Erectile Dysfunction

Scientists once believed erectile dysfunction (ED) - was a problem only of the mind and not of the body. But recent data suggest a physical (or organic) cause in more than half of all cases, especially those involving older men. In any case, experts believe it affects up to 30 million American men. But what is involved in impotence and what is available to correct it? The following information should help you talk to your urologist about this frustrating issue and some of the options - including vascular surgery - that may help solve it.

What happens under normal conditions?

The internal structure of the penis includes two cylinder-shaped chambers, the corpora cavernosa. Filled with spongy tissue containing smooth muscles, fibrous tissue, veins and arteries, these chambers run the length of the organ and are surrounded by a membrane cover, called the tunica albuginea. The urethra, the channel through which urine and semen exit the body, is located on the underside of the corpora cavernosa and is surrounded by spongy tissue. The longest part of the penis is the shaft, which ends in the glans. The meatus is the opening at the end of the urethra.

Erection is the culmination of a complex set of physical, sensory and mental events, involving both the nervous and vascular systems. It begins when physical or psychological stimulation (arousal) causes neurotransmitters or impulses in the brain (chemicals such as dopamine, acetylcholine and nitric oxide) to tell the muscles of the corpora cavernosa to relax, allowing blood to fill the organ's tiny open spaces. As the tunica's fibrous or elastic tissues trap the blood, the penis engorges, or increases, in an erection. When stimulation finally ends, usually after ejaculation, pressure inside the organ decreases, as the muscles contract. Blood then flows from the penis and the penis returns to its normal shape and size.

What is erectile dysfunction (ED)?

Erectile dysfunction refers to the inability of a man to attain and maintain an erection sufficient for intercourse. It occurs when there is reduced blood flow to the penis or nerve damage, both of which can be triggered by a variety of factors. Scientists once believed that ED was an emotional issue alone. But today they know that physical factors are just as important as psychological triggers - stress, marital/family discord, job instability, depression and performance anxiety - in provoking this problem. It is important to note that hundreds of medications can also contribute to impotence while they fight allergic reactions, high blood pressure, ulcers, fungal infections, anxiety, depression, and psychoses.

Who is at risk for erectile dysfunction (ED)?

A man is at risk if they suffer from:

Vascular diseases: Hardening or narrowing of arteries, often associated with high cholesterol, can also restrict blood flow to the penis, particularly if you are over 60. Because smoking can lead to any of the factors responsible for vascular problems - such as high blood pressure - it is probably an important factor in both arterial disease (atherosclerosis) and ED.

Neurologic disorders: Spinal cord diseases or injuries, brain injuries, multiple sclerosis, Parkinson's disease and other progressive diseases can interrupt nerve impulses to and from the brain. Diabetes poses both neurological and vascular problems because it damages small blood vessels and nerves throughout the body, impairing the impulses and blood flow necessary for an erection.

Other conditions/illnesses: In addition, other chronic illnesses such as cancer and well as hormonal imbalances and penile disorders can disrupt the nerve impulses and blood flow necessary for normal erections.

What are the symptoms of erectile dysfunction (ED)?

Failing to achieve and/or sustain an erection is the primary sign of erectile dysfunction. But diagnosing the specific cause and prescribing appropriate treatment usually require a variety of tests, beginning with a complete history and physical examination.

Your doctor may order additional laboratory tests to assess any conditions that may be interfering with normal erectile function, particularly arterial flow to the penis. A blood test, for instance, is normally used to reveal blood lipids and triglycerides, both of which indicate atherosclerosis if elevated. A urinalysis identifies protein and glucose levels that can suggest diabetes.

While these analyses focus on your chemical status, erectile function tests are the principal tools your doctor will use to tell how the blood vessels, nerves, muscles and other tissues of your penis and pelvic region are working. Among them, penile nerve function tests - squeezing the head of the penis and measuring various responses - can determine if there is sufficient sensation in the penis. Nocturnal penile tumescence (NPT), or healthy involuntary erections during sleep, may rule out psychological issues and instead suggest nerve function or blood supply problems.

An imaging technique called duplex ultrasound may also be used. It monitors the behavior of moving structures and might provide some of the best data since it can evaluate blood flow, vein leaks, scarring of erectile tissue and some signs of atherosclerosis. During the test, an erection may be produced by injecting the stimulator prostaglandin into the body and then measuring vessel expansion and penile blood pressures, both of which are compared to the limp penis. In either case, duplex ultrasound can illustrate a specific blood vessel disease that may rule out a need for vascular surgery.

How is erectile dysfunction (ED) surgically treated?

The past several decades have ushered in a new treatment era for erectile dysfunction. Because of the advent of many advances, today urologists are helping millions of impotent men perform better and longer.

Penile prostheses: Surgically implanted devices to ensure stiffness have become highly reliable therapeutic solutions. Vacuum constriction devices have proven to be safe alternatives in stiffening the penis by drawing blood into the organ with a pump and holding it with an "occluding band." Penile injection therapy is a relatively quick and effective way to send vasoactive drugs directly into the corpora cavernosa where they expand the vessels, relax the tissue and increase blood flow for an erection. Furthermore, sildenafil citrate (Viagra) has become the treatment of choice for millions of men who have experienced the drug's ability to boost levels of cyclic guanosine monophosphate (cGMP), a chemical factor in metabolism responsible for relaxing blood vessels.


Vascular surgery: Although options are varied, not everything is for everyone. In fact, two vascular approaches developed over past decades to restore penile blood flow disrupted by disease or trauma are viable for only a select few:

Penile arterial revascularization: This procedure is designed to keep blood flowing by rerouting it around a blocked or injured vessel. Indicated only for young men (under 45) with no known risk factors for atherosclerosis, this procedure is aimed at correcting any vessel injury at the base of the penis caused by adverse events such as blunt trauma or pelvic facture. When such an event leaves a penile vessel too injured or blocked to transfer blood, the surgeon may microscopically connect a nearby artery to get around the site, clearing the pathway so enough blood can be supplied to the penis to enable an erection.

Venous ligation surgery: This procedure focuses on binding leaky penile vessels that are causing penile rigidity to diminish during erection. Because venal occlusion, necessary for sufficient firmness, depends on arterial blood flow and relaxation of the spongy tissue in the penis, this approach is designed to intentionally block off problematic veins so that there is enough blood trapped in the penis to create an appropriate erection. Since long-term success rates are less than 50 percent, this technique is rarely a choice for correcting ED.

In fact, you are not a candidate for either penile vascular surgeries if you have insulin-dependent diabetes or widespread atherosclerosis. You are also not suited if you still use tobacco or experience consistently high blood serum cholesterol levels. Neither of these surgeries will work if you have injured nerves or diseased and/or generalized damaged blood vessels. Also, if you are a candidate, be aware that vascular surgeries are still considered experimental by some urologists and may also not be covered by your insurance.

What can be expected after surgical treatment for erectile dysfunction (ED)?

Most of the best known treatments for ED have excellent track records for being both effective and safe. But in making your choice, make sure to discuss the potential complications of each option with your doctor.

For instance, the good news about a penile prosthesis is that it does not usually affect urination, sex drive, orgasm or ejaculation. But on rare occasions, these semi-rigid, silicone-covered metal rods or hydraulic devices can cause pain or reduced sensation. While injections can initiate erections within 15 minutes to several hours, be aware that they also can produce prolonged or painful ones, not to mention a hardening of connective penile tissue (fibrosis).

At the same time, a vacuum constriction device should take only one to three minutes to do the job, usually with no serious side effects if used properly and limited to 30 minutes.

It has a 75 percent success rate, primarily because it is a subtle solution that works within the hour. But on rare occasions, it can cause headaches, flushing, and indigestion. Also, if you have heart disease or low blood pressure, the Food and Drug Administration (FDA) cautions a thorough examination before getting a prescription.

Penile arterial revascularization can restore function in men, although only a small percentage of them undergo the procedure. While few patients experience postoperative complications, side effects can include penile scarring, numbness and shortening all of which can cause further impotence.

Venous ligation surgery, although rare, is also known to cause penile shortening, along with other problems. Also, improvements with venous ligation surgery may be temporary.

Frequently asked questions:

When is venous surgery for erectile dysfunction successful?

It has been most successful in young men with abnormally draining veins since birth who have never had a full erection. It has also been used in some patients with an injury to the covering tunica albuginea or the corpora cavernosa.

I am interested in vascular surgery, what should I be aware of?

Realize this is not a surgery for everyone. If you meet the criteria mentioned previously, you will want to find a specialist with a track record of having done these microsurgical techniques. Be aware, however, that penile vascular solutions are still experimental; few specialized urologists or vascular surgeons are trained to do either procedure. If your doctor is not one of them, you will need to ask for a referral. You will also want to get a second opinion if this treatment option is recommended, given that there are few patients who are good candidates.

If I choose vascular surgery, what should I ask my surgeon?

Once you have found a surgeon, ask about his or her experience and outcome record with penile arterial revascularization. Make sure that you understand the potential outcomes and possible complications. Also, ask how the particular approach stacks up against other treatment choices for you. For instance, vacuum devices and oral or injection therapies still work for some people. Penile prostheses, the most widely used surgical technique for ED, usually have a more favorable outcome than vascular techniques.

Is age a factor in impotence?

Yes. Data suggest that while not an inevitable part of aging, the risk of impotence increases as we grow older. About 5 percent of men at age 40 complain of the problem, while between 15 and 25 percent at age 65 experience it. Some experts suggest the numbers may be underreported since men are still embarrassed by this physical and psychological issue. However, the reassuring news is that it is treatable in all age groups.

What should I remember about erectile dysfunction?

Impotence, or the consistent inability to sustain and maintain an erection, is a widespread problem. It may affect as many as 50 percent of men between ages 40 and 70. Luckily, doctors can identify physical causes involving blood flow, nerves or other mechanical issues involving the penis, which can also be addressed with modern technology. In fact, oral drugs, vacuum devices, injectable medications, psychotherapy and even surgery have made impotence very treatable. The promising news is that new drugs are sure to join existing non-invasive treatments while other experimental options, such as gene therapy, are on the horizon. In addition, ongoing modifications of today's standard treatments will eventually improve the picture for impotent men.

APA Reference
Staff, H. (2021, December 22). Surgical Management of Erectile Dysfunction, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/male-sexual-dysfunction/surgical-management-of-erectile-dysfunction

Last Updated: March 26, 2022

Antidepressants and Libido

Depression surrounds people with a life-draining cloud that typically saps their joy, energy and desire for work, play, food and sex. Once recognized and properly treated, depression can usually be relieved, restoring the zest for life and all it has to offer. Depression can be lifted in two-thirds to three-fourths of patients by antidepressant medications.

But for many people treated with psychiatric drugs, the remedy, though highly effective in making life meaningful again, falls short in a major sphere. Instead of raising libido and the ability to achieve sexual fulfillment, popular antidepressants commonly cause a loss of interest in sex and block the ability to achieve sexual satisfaction.

As one 40-year-old man whose depression responded well to medication told his psychiatrist, "I'm feeling much better and enjoying my work again. But I'm having a problem at home."

If psychiatric drugs were taken like antibiotics, for 10 days or so, patients and their partners could easily cope with a temporary disruption of their sex lives. But many chronically depressed people require treatment for many months or years. For some, sexual crippling can be a serious problem that prompts them to stop taking the drugs, often without telling their doctors.

Yet, according to psychopharmacologists who spoke at the annual meeting of the American Psychiatric Association all the way back in 1996, there are less drastic solutions, including taking brief drug holidays and switching to a new drug that seems to have little or no ill effect on sexuality.

Detecting Sexual Problems

Physicians rarely hear about a vast majority of people whose sex lives are disrupted by antidepressant drugs. Unless asked directly, which experts say happens infrequently, patients rarely volunteer such information. And unless the physician assesses the patient's sexual function before prescribing medication, it may be impossible to tell whether the drug has caused or contributed to sexual dysfunction.

Drug-related problems, which occur in women as often as in men, may include decreased or lost libido; inability to achieve an erection or ejaculation, and delayed or blocked orgasm.

Dr. Robert T. Segraves, a psychiatrist at Metrohealth Medical Center in Cleveland, suggested that before prescribing a medication that can have sexual side effects, the physician should inform the patient that the drug "may cause sex problems, and thus we need to establish a baseline of sexual functioning beforehand." He insists that when patients are asked directly about sexual functioning, they usually give honest answers. A "routine sexual history," Dr. Segraves said, should include questions appropriate to the sex of the patient, like these:

  • Have you experienced any sexual difficulties?

  • Have you experienced any difficulty with lubrication?

  • Have you experienced any difficulty with erection?

  • Have you experienced any difficulty with orgasm?

  • Have you experienced any difficulty with ejaculation?

If the patient is reluctant or seems to give unreliable answers, Dr. Segraves suggests that the patient's spouse or sex partner be interviewed.

When, after weeks or months of therapy, the patient's depression has lifted significantly, the presence of any sexual problems should again be ascertained. Sometimes, Dr. Segraves cautioned, the problem stems more from the relationship than the medication. For example, the drug is not likely to be the cause when a patient's libido is depressed with a spouse but not with another partner, or when orgasm can be reached through masturbation but not coitus. But when a once-potent patient has erectile problems with a partner and also has no spontaneous nocturnal erections, the drug is a likely cause.

Many Options Available

Dr. Anthony J. Rothschild, a psychiatrist at Harvard Medical School and McLean Hospital in Belmont, Mass., outlined various possible solutions. One would be to decrease the dose, which is not always possible without losing the therapeutic benefit. Another is to plan to engage in sexual activity just before taking one's daily dose, which he said is often impractical. A third is to try sexual stimulants like yohimbine, which can be frustrating because their effects are not consistent, or to give a second drug, like amantadine (Symmetrel), to counter orgasmic failure induced by the antidepressant.

Dr. Rothschild has tested a fourth solution on 30 patients who experienced sexual dysfunction from an SSRI (serotonin-reuptake inhibitor drug): weekend holidays from the drugs, in which the last dose for the week is taken on Thursday morning and the medication is resumed at noon on Sunday. He reported that sexual function improved significantly in the drug-free period for patients taking and Paxil, but not for those on Prozac, "which takes too long to wash out of the body." He said the brief drug holidays did not cause a worsening of depressive symptoms.

There are other ways to deal with the sexual side-effects of antidepressants

APA Reference
Staff, H. (2021, December 22). Antidepressants and Libido, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/medications/antidepressants-and-libido

Last Updated: March 26, 2022

Why Diagnosing Sexual Problems Is So Difficult

There is no set definition of what a "normal" sex life is. Individuals and couples vary widely in terms of how often they have sex and what that encounter involves. For some couples, once a week or month or even a few times a year may be perfectly normal. A sexual encounter may not always include intercourse, and each partner may not have an orgasm every time. And nearly everyone goes through periods when interest in sex or the ability to perform is hindered. This lack of a clear standard can make it difficult to diagnose whether or not someone has a "problem.".

The Merck Manual of Diagnosis and Therapy uses three phrases that can be helpful in judging whether a difficulty you're experiencing is actually a problem with sex:

  • Persistent or recurrent: It isn't an isolated or occasional event but persists a long time.
  • Causes personal distress: It upsets you and causes unusual anxiety.
  • Causes interpersonal problems: It hurts your relationship with your sexual partner.

The latter two categories are the most important. Many people may experience levels of desire or changes in function that don't cause distress and do not impact their relationships. These changes would not then be considered a problem. However, these same changes may be very stressful for other people or couples and would be considered a sexual problem. Problems vary from person to person.

Another complicating factor is that most sexual problems cannot be traced to one specific cause. Rather, they result from a combination of the physical and the psychological. Proper sexual functioning depends on the sexual response cycle, which includes:

  • An initial mindset or state of desire.
  • The flow of blood to the genital areas (erection in men and swelling and lubrication in women) in response to arousal.
  • Orgasm.
  • Resolution, or a general sense of pleasure and well-being.

A breakdown in one of the cycle's phases can be responsible for a sexual problem, and that breakdown can stem from a variety of causes.

Role of diabetes, smoking and other problems

According to the American Medical Association, sexual problems often result from physical conditions such as:

  • Diabetes
  • Heart disease
  • Neurological disorders (such as stroke, brain or spinal cord injury, or multiple sclerosis)
  • Pelvic surgery or trauma
  • Side effects of medications
  • Chronic diseases such as kidney or liver failure
  • Hormonal imbalances
  • Alcoholism and drug abuse
  • Heavy smoking
  • The effects of aging

Psychological causes might include:

These sets of causes often "play off" one another. Certain illnesses or diseases can cause people to feel anxious about their sexual performance, which, in turn, can make the problem worse.

When doctors suspect a sexual problem, they usually run a series of diagnostic tests to see if there is any physical cause such as certain medication, hormonal imbalance, neurological problem or other illness or some other mental disorder such as depression, anxiety or trauma. If any of these causes are found, then treatment will begin. If such underlying problems are ruled out, then the nature of the relationship between the two people must be considered. A sexual problem may be "situational." That is, the issues are specific to encounters with a certain person in a particular situation. In such cases, therapy is usually recommended for the couple.

APA Reference
Staff, H. (2021, December 22). Why Diagnosing Sexual Problems Is So Difficult, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/main/why-diagnosing-sexual-problems-is-difficult

Last Updated: March 26, 2022

Loneliness and Fear of Rejection

Fear of rejection and a negative self-image are associated with persistent feelings of loneliness. Find out about loneliness and how to attract a person who is right for you.

Replace loneliness thinking and self-depreciation thinking with positive thinking that makes you happier and more attractive to others.

  • Do you want to improve your ability to form new relationships?
  • Do you fear or dislike being alone?
  • Has a relationship ended and you want to feel better about it?
  • Do you feel lonely too often?
  • Are you too worried about pleasing others?
  • Loving and taking good care of yourself is the first step to self-confidence and respect from others.

Index

WHAT CAUSES FEAR OF REJECTION AND FEAR OF BEING ALONE?

Do you feel uncomfortable in situations such as meeting new people, speaking in front of groups, dealing with someone who is upset, having to tell someone about a mistake, or divulging your inner feelings? Fear of rejection may underlie all of these situations. If you really value other people and how they feel about you, it is natural that you would feel some fear of rejection. Whenever there is the possibility for actual rejection, most people feel some fear. Fear of rejection is increased by the importance of the other person to you, by your perceived inexperience or lack of skill in dealing with the situation, and by other factors.

However, some people suffer more intense levels of rejection for longer periods in their life than other people. Deeper issues such as those listed below may be increasing your fear of rejection.

FEAR OF REJECTION AS FEAR OF BEING ALONE
Underlying your fear of rejection might be a fear of being or living alone. You might fear ending up all alone in the world with no one who really cares.

FEAR OF BEING ALONE AS FEAR OF NOT BEING ABLE TO CREATE YOUR OWN HAPPINESS ALONE
The thought of being all alone in the world is not in itself something to panic about. While some people panic at the thought--others delight at the thought. If you believe that you can take care of your own needs well and be happy even if you are alone, then being alone is nothing to fear. If you believe that you need others to take care of you and "make" you happy, then you are too dependent on others and their absence is something to "panic" about.

PRACTICE: Examine the degree to which you can create your own happiness--even when alone. Examine how too much dependence on others for happiness can undermine your feelings of confidence with others and lead to fear of rejection.

FEAR OF REJECTION AS NEGATIVE FEEDBACK ABOUT WHO YOU ARE
If your self-image is too closely tied to what others think of you or how well you relate to others, then fear of rejection can be a threat to your whole self-image. That in itself can create a lot of anxiety. If you are used to defining the core of your Self or your future as "popular," "married," "well-liked," "a leader," or the like, then you threats to any of these self-concepts may create a great deal of anxiety. Or you may view your life script as being married, having children, or having a number of close friends. To the degree that any of those expectations are threatened, and you cannot see how you can be happy without them, then you will experience anxiety.

How can you overcome fear of rejection due to threat to your self-image or life script? You must define yourself and your essence in a way that does not depend upon what others think. For example, if you define yourself as someone whose main goals are to seek happiness for yourself and others; treat others kindly, honestly, and assertively; be a person of integrity; and not worry about other's reactions to you, then meeting your primary goals will not be dependent upon what others think. Your happiness will be in your control, and you will feel much more secure.

On the other hand if you define yourself primarily as someone who must be loved and accepted by others, then your happiness will be in their control and you will always fell insecure and anxious at some deep level.

PRACTICE: (1) Make a list of at least 10 important general characteristics of yourself. (2) Examine items on that list which are "interpersonal" in nature. How would you feel about yourself if all of these were threatened at once. Could you still love, respect, and take good care of yourself and still be a happy person? If not, then try to re-examine what changes need to take place in your beliefs about yourself to become less dependent upon others and their view of you.

 

Factors Affecting my Fear of Being Alone 

(The higher your "attachment," the higher your fear of rejection!)

The more emotionally "attached" you become to someone--the more important you believe they are to you--the more anxiety you will create about losing them. One of the best ways to control your fear of rejection is to not get overly attached to someone. The following factors are especially important sources of attachment that is too much, too soon.

1. HOW "SPECIAL" THE OTHER PERSON IS--the more you want to be wanted by them, the more anxiety it will cause. Many people develop a fantasy or script about what love should be like. For example many people expect to marry their "first love," or the person that they have called their "soul mate." Letting yourself develop and fantasize about the future with a person increases attachment and anxiety about the expectations or plans not coming true. Any little event that makes the plan seem likely makes you feel elated; any event that makes it seem unlikely makes you feel devastated. You can get on an emotional roller-coaster, dependent upon these little signs of success or failure in the relationship. You may then drive the person away by being too emotional or needy.

To prevent this emotional roller-coaster, don't develop the expectations prematurely. Don't fantasize and plan for the future prematurely. Always know that it may not work out and have alternative plans that you know you can be happy with.

2. BELIEVING ONLY ONE PERSON IS RIGHT FOR YOU vs. many are right. The fact is that many people who thought someone was the only person for them and thought their life was ruined because they could not be with that person later found someone else with whom they were much happier. Remind yourself that, no matter how much you may feel that is the only person for you, you can be wrong!

3. HOW CONFIDENT YOU ARE IN YOUR ABILITY TO HELP CREATE A HAPPY RELATIONSHIP
The less confident you are that you can create a happy relationship or get a person like you want, the more likely you are:

(1) to pick someone with whom you will not be satisfied. Or you may wait for others to approach you. People who tend to use or dominate you may be the very type of more outgoing people who will seek you. Then you may later wonder why you keep getting into relationships with people who don't treat you well. Learn to be active in the process of meeting others and getting involved in a relationship. Keep the initiation of mutual activities closer to a 50-50 level, and don't just go along for the ride when you are seeing red flags.

(2) to pick someone who "needs" you to take care of them, because they do not take care of themselves well. Frequently in a codependent relationship, the codependent partner believes his/her "weak" partner is so dependent upon them that they will not leave them. The codependent partner may also believe that he/she is not very attractive and believes he/she could not attract someone as attractive as this irresponsible partner if the other was not so needy. They are not willing to risk finding someone who is not needy, who would only want them for how much they enjoyed being with them.

They are afraid no one they would want would really be attracted to them or stay with them. If you are one of these people, it is important to test that assumption. You probably have many other desirable qualities another would love that you don't appreciate about yourself. See the section below on "stereotypes". Also, if you really believe that you do not know how to create fun and happiness for yourself, you may want to work on that. That could make a difference in attracting a more fun loving, happy person if that is the type of person you want.

4. SHARING EVENTS--ESPECIALLY CONVERSATIONAL AND PHYSICAL INTIMACY
Sharing life events increases attachment. Just being together in a variety of circumstances seems to build some degree of closeness. However, sharing important life events, sharing of one's innermost feelings and thoughts, and physical intimacy are powerful forces that can lead to very strong "attachment" (to the degree that these events are positive). If you have gained a high degree of intimacy, that is great! However, it does not mean that you can't find it with someone else. On the contrary, it means that you have learned how to be intimate, and your chances are very high that you can find at least that much intimacy again. Most often people move into better--not worse--relationships after one has ended.

SUMMARY: Some "do"s and "don't"s to keep from getting too attached too early.

  • Constantly remind yourself, "I want to control my anxiety and fear of rejection. Don't get too attached too early."

  • Question thoughts like, "This is the only person I can be happy with." · Don't fantasize about the future with this person.

  • Avoid sexual involvement that is too early (before strong, reciprocal relationship factors are satisfactory).

  • Don't focus all your thoughts and fantasies on this one person--especially before you have established a strong dating relationship. Fantasize about a variety of people (even movie stars, or imaginary people) so that you relate to this person as a real person--not as a fantasy.

WHO IS THE "RIGHT" PERSON FOR YOU--WHO WILL REALLY WANT JUST YOU?

RELATIONSHIP INTIMACY HIERARCHY

There are many levels of closeness and intimacy with other people. Examples include marriage, closest family and friends, close friends, friends, friends for specific needs (eg. work, bowling, church), acquaintances. There are many differences between different levels of intimacy. The amount of physical and communication intimacy, time spent together, commitment, sharing, helping each other, etc. will vary with each level.

Every person you contact in your life has some maximum potential level for achieving intimacy with you. This maximum level will depend upon many factors. Many people have the potential for lower levels of intimacy (such as acquaintance), but few have the potential for the highest levels (such as marriage). The fact that a person only achieves a certain level does not mean that the relationship "failed"--it merely achieved its maximum potential level of intimacy and could go no further.

IT'S OK THAT MOST PEOPLE YOU MEET AND DATE ARE NOT THE RIGHT PERSON
How many people out of 10,000 people in the appropriate age and sex group would you really want as your "significant other"? How many are really right for you? Most people you meet/date will not be a good enough match, so why beat yourself up when the relationships end. The relationship was almost certainly a mismatch.

Instead, try to understand the reasons the relationship ended. To what degree was it due to differences between the two of you? If the reasons partly include that you haven't acted in ways consistent with your own standards for yourself, then change your thinking and actions for the next person .

THERE ARE MANY "RIGHT" PEOPLE
If you believe that only one person is "right" for you, then you will become extremely dependent upon that person. Putting a person on a pedestal like this will most likely lead to dependent feelings and behavior that actually causes both of you to be unhappy. You may try so hard to please and keep that "person you can't live without" that you end up losing your sense of freedom to be yourself and giving up your own happiness. In turn you will become increasingly unattractive to your "pedestal" person.THE MAIN FACTORS CAUSING A PERSON TO WANT TO BE WITH YOU ARE INHERENT IN WHO YOU ARE!
Even though this may seem obvious, this is a very powerful statement! The factors that affect how much one person is attracted to another include the following:

  • General beliefs and values: cultural, religious, moral, political, family, sexual, etc.
  • Background: culture, family, career, education, organizations, etc.

  • Relationship factors: previous history, control style (dominant-submissive or assertive), problem-solver, conversational style, empathy, independence-dependence, emotional expressiveness, playfulness, romantic style, liberated-traditional sex roles, etc.

  • Interests: career, cultural, music, sports, education, romantic, etc.

  • Personal characteristics and habits: honesty, responsibility, ambition, achievement, caring/understanding, openness, emotionality, independence, self-esteem, positiveness, cleanliness, orderliness, stability, assertiveness, adventurousness, sense of humor, etc.

  • Personal problems and bad habits (big TURN-OFFs to almost everyone): addictions, dishonesty, cheating, withdrawal, suspiciousness, irresponsible, cruel, aggressive, extremely dominating or needy, emotionally out of control, etc.

The above factors are the kinds of factors that will be the major determinants of whether you and another person will be happy together. Most of these factors are determined by parts of yourself that are highly stable over many years. You probably don't want to change most of these aspects of yourself. If you just act naturally, you will reveal these true aspects of yourself to your partner (and vice-versa). Your partner will accept or reject you on the basis of how well these factors match their own factors (and vice-versa). Therefore it should be clear that nature tends to bring people together or apart on the basis of who they really are, so why try to hide?

Research and clinical experience shows that overall, the more alike partners are-especially in aspects important to the partners-the more likely the relationship will succeed and be happy.

If your partner is "right" for you, he/she will like you as you really are, and they will be attracted to you. Out there somewhere are probably many potential partners who are a lot like you! These are the people who will be naturally attracted to you. Think about it for a minute. How would you feel about being with a partner who is a lot like you in most important aspects?

HOW DO YOU ATTRACT A PERSON WHO IS "RIGHT" FOR YOU?

CREATING A HAPPY YOU CREATES A CONFIDENT, ATTRACTIVE YOU
Learning how to create your own happiness alone is a key part of building self-confidence and overcoming fears of rejection and loneliness. As long as you do not believe that you can create your own happiness and enjoy life alone, then you will be less confident and more dependent on others' creating your happiness. This dependence makes being in a relationship much more important, and therefore increases anxiety about being alone and increases fears of rejection. For example I have had many clients who thought they could only be happy if they get married and have a family. Yet some were fearing age would overtake their ability to have children, and no partner was in sight. They developed a terror of not having their happy family dream come true and living their lives alone. That fear caused a desperate need to marry. They became very "needy," manipulative, and scared potential partners away. As their desperation rose, their chances sank.

They escaped the catch by learning how to be at peace with the thoughts that they might never be married and might live alone the rest of their lives. They learned how to take care of themselves and how to be happy alone. The irony is that once they didn't need marriage so much, they were much more likely to get married. Because now they were less fearful and "needy" and more confident and relaxed.

How to become happier alone. If you don't have many interests which you enjoy alone, it is important to begin exploring and finding more. If you have few interests that you can do alone, because you have spent most of your life either with other people or doing what others wanted you to do, then it is especially important for your own independence that you explore new potential interests. You can learn to like activities you currently don't like. Remember this, if many other people love this activity there must be some fun in it. All you need to do is learn how to enjoy it.

  • Many activities are difficult to enjoy until you have learned the basics about how to participate in them. Most sports are that way, but even music and the theater can take some time to appreciate. Don't give up easily. Give the new activity a chance over a reasonable period of time.

  • Many people hate to do things alone, so they refrain from activities. A common reason is that they are afraid of what others will think about their coming alone. However, if you continue to do activities alone, you can eventually desensitize yourself to most of those fears.

  • Career interests, sports, music and the arts, reading, entertainment events, hobbies, do-it-yourself projects, taking classes, walks, shopping, bike rides, or taking oneself out for dinner are but a few examples of activities people do to entertain themselves.

  • Initiating activities with other people and joining organizations are examples of ways that you can create your own happiness with others without being in an exclusive relationship.

  • Finally, if you are generally happy and enjoy life, your positiveness and happiness can help them be happier as well. And that will make you more attractive to anyone who wants to be happy themselves..

CREATING A HAPPY OTHER CREATES AN ATTRACTIVE YOU
You are attractive to another person to the degree that that person perceives you as potentially contributing to their happiness. You are not responsible for their happiness, you are only being yourself and giving gift of your presence and actions. You are only hoping these gifts will contribute to their happiness. Each person is ultimately responsible for their own happiness.

PRACTICE:1) List all of the characteristics you want in another person. 2) Make a "RELATIONSHIP RESUME" which describes all of your personal beliefs, attributes, interests, communication skills, which might be important in appealing to the type of person you wish to be with or marry. 3) If you want to better create your own happiness, add exploration of new interests to your "to do" list.

WHAT STOPS YOU FROM APPROACHING OTHERS OR BEING YOURSELF WITH THEM?

1. EXCUSES

Self-labels that prevent action. "I'M TOO...shy, heavy, boring, quiet, intellectual, much of a loner, afraid, conservative, inexperienced, clumsy, nervous, emotional, demanding, afraid of intimacy, ETC.

PRACTICE: Make a list of the labels that stop you from approaching others or being yourself. Then take each one and decide the degree to which you intend to change it or to accept it as it is. Keep in mind that there are many happily married persons who fit all of the above descriptions and realize that, you are looking for someone who would be happy with a person just like you.

External events or commitments that keep you from pursuing a relationship now. The difference between an EXCUSE and a CONSCIOUS CHOICE is whether or not you are being honest with yourself about all of your underlying motives. If you are avoiding involvement primarily because of fear of rejection or failure, then that is very different from saying that you are doing it because you are too busy.

It is ok not to be in a relationship or looking for one. You may want to be alone now. If you want to pursue other parts of your life and develop yourself into the person you want to be, that can be very healthy for building your own self-esteem and relationship potential. When you are ready for a relationship, you will be more the person who will be attractive to the type of person you want. If you aren't happy with yourself now, you might be wise to focus on that first!

PRACTICE: If you are not sure whether you are being honest with yourself about doing what might be helpful to improve a relationship or meet someone, try getting in touch with underlying feelings and beliefs, exploring new creative alternatives and possible outcomes. Then make a conscious decision based upon your true underlying motives.

2. STEREOTYPES OF POTENTIAL PARTNERS
Women's stereotypes. Women often say they can't find a men who can be both (1) sensitive to their feelings, romantic, loving, and fun and also (2) responsible, somewhat confident, and somewhat successful in their education and/or career. Women often think that men are "only interested in sex or the size of my breasts," "say they want an equal relationship, but are afraid of successful women". These are a few of the more common stereotypes that may fit many men, but also don't fit many others. Don't accept someone with whom you can't be happy. After all, what difference does it make if other men are that way if the man you're with isn't.

Men's stereotypes. Many men think that most women are primarily interested in money, expensive cars, restaurants, and gifts. Or, that they only want a man who is extremely good looking and charming with a good line (can make a good impression, but would make a poor partner).

PRACTICE: Make a list of your stereotypes which prevent you from approaching others or being yourself. Identify ways that you try to put up a front to make a good impression based upon your stereotypes. For example, you may believe that you have to constantly be clever and funny because that is what you think women/men are looking for. In fact, you may be turning the other person off, because you are being "phony" and not intimate about who you really are. You are making the mistake of underestimating the person you are with. You think that they can't handle honesty as well as you.

Treat potential partners as if he/she were as mature as you
and as if he/she were the kind of person you would want.

(Then you will probably be more attractive to them.)

3. LOW SELF-CONFIDENCE EVALUATION BIAS
The low self-confidence evaluation bias means underestimating how well people like you. A research study at the University of Oregon had single women evaluate their conversations with single men. The women evaluated the men on a number of variables including if they would like to go out with them. To their surprise low-frequency dating men performed just as well as high-frequency dating men in actual ratings by the women. However, the low-frequency dating men UNDERESTIMATED how well the women liked them, and the high-frequency dating men OVERESTIMATED how well they were liked. This became a SELF-FULFILLING PROPHESY. The men who overestimated how well they were liked would go ahead and ask the women for a date, while the ones who underestimated how well they were liked, didn't.

Conclusion: If you have low self-confidence in how others perceive you, then you are probably UNDERESTIMATING how much they like you. As a result, you don't approach people as much as you would like. If you start OVERESTIMATING their reactions, you may approach more people and have greater success.

INTERNAL CHANGES TO INCREASE YOUR CHANCES FOR A SUCCESSFUL RELATIONSHIP

FOCUS ON THOUGHTS SUCH AS THE FOLLOWING:

  • You can create your own happiness and take care of yourself-You don't NEED (must have) anyone else to do it for you.

  • Love yourself unconditionally the way you are. Even though you may never be the person you would ideally like, learn to let go of "shoulds." Instead (1) replace the "shoulds" with "wants," and (2) learn that your basic self-worth begins with loving yourself unconditionally because you are alive and a human being. You can love yourself despite any imperfections and accept those imperfections as part of yourself. You can also believe that someone like you could love you the way you are now (despite any imperfections), you don't have to wait until you are perfect before you seek a relationship.

  • Attempt to focus on being your "higher self" while dealing with other people (vs. trying to be what you think others want you to be). Putting your higher self in control means choosing to think and act out of empathy and love for self and others, seeking happiness for self and others, seeking win-win solutions, etc.

  • Seek those who will like you as you really are. Choose to be closest friends with those who know all about you and like/love you the way you are. Reveal your inner feelings and thoughts more honestly with potentially close friends. This openness will show confidence and acceptance of yourself, reveal trust in the other, and serve as a test to see if the other can accept you as you are. If they can't accept you as you are, then they don't make very good candidates for close relationships. (Don't be so open and honest with people you have a reason not to trust.)

  • If you have been successful before, you can be successful again. If you are feeling discouraged about finding someone or feeling bad about yourself and if you have had close friends, relatives, or relationships in the past, remember that at least one other person liked you the way you are. You know you can develop another relationship at least as good as one of those. If you have grown since then, you will probably have a better relationship.

  • You may want to change for yourself. If you think you aren't yet the person you believe will attract the kind of person you want, then perhaps you need to make your first priority becoming that person. Focus on being the person you want to be as much as possible.
  • The person you are or want to be will be very attractive to the type of person who is "right" for you. Would you be attracted to someone else who also was like you?

 

THOUGHTS and ACTIONS TO OVERCOME FEARS OF REJECTION and INCREASE CHANCES FOR A SUCCESSFUL RELATIONSHIP

HAPPINESS RULE
Try following the happiness rule: Seek out people who can contribute most to your overall happiness and support your being the person you want to be. Many of these people will be similar to the type of person you really want to be. Avoid spending too much time with people who take away from being that kind of person.

SELF-SELECTING RULE
Follow the self-selecting rule: Be the person you really want AND tell others your true inner feelings and thoughts more assertively. Even though you may fear that others may not like who you really are and reject you, that is good. Being open separates those people who are "right" for closer relationships from those who are not. For example, if you meet Sally (who is not potentially a close friend) and hide who you really are from her, it may take her a long time to find out what you are really like and reject you. In this case you have both wasted a lot of time. If you present yourself honestly and openly from the beginning, you will attract or repel people much faster. This saves a lot of time.

Incidentally, a bonus of this approach is that most people prefer honesty and the self-love and self-confidence that openness reveals, so you may be more appealing to more people.

GIVING WITHOUT EXPECTING ANYTHING IN RETURN
Focus on your actions not their reactions. An important lesson about anxiety is that when we focus on external outcomes that are beyond our immediate control, we give up control of our emotions and will begin to feel anxious and helpless. The same is true in meeting people, approaching people, talking to people, trying to help people, trying to entertain people, etc. If you focus on their evaluation or approval of you, spending time with you, giving back to you, or any other reaction outside your control, you increase your anxiety and helplessness.

Therefore, focus on approaching people, being friendly, your talking and listening, your openness and honesty, your assertiveness, and your thinking positive thoughts. You can control what you think and do. The result will be that you are setting attainable goals that you have control over. Knowing that can give you peace.

In the long run, you may not want invest much energy in a relationship if you do not receive enough of what you want. However, in the short run, focus on your actions as ends in themselves to "practice your act" and be the kind of person in a relationship that you want to be. Eventually others will respond positively as you get better at it and as you approach the right people.

Also, say this to yourself, "My gift recipients have the freedom to do whatever they want with my gifts (my attention, help, etc.)--since it is now theirs." It is OK for them to reject the gifts and you can still feel good because you gave in the spirit of true unconditional, non-demanding love.

INVITATIONS AS GIFTS
Do you ever feel anxiety about inviting someone to do something with you? If so, try viewing your invitation as a gift in the spirit just discussed above. It is a gift in two ways: (1) it is a compliment to the other person that you care enough about them and find them attractive enough to give the invitation and (2) your time is a gift which is offered to them. Thus even if they reject the offer to spend time together, they still have received the gift of the compliment. Accordingly, start stating your invitations more as compliments." EXAMPLE: "Mark, I've really enjoyed talking with you, I would really like for us to get together again soon." This is a very effective and efficient way to give an invitation.

ASSERTION TRAINING
Learn the difference between non-assertive behavior ("I lose, you win"--passive, indirect, avoidance); aggressive behavior."I win, you lose"--dominating, controlling, selfish); and assertive ("win-win"-caring, calm, understanding, diplomatic, honest, but direct and firm behavior). The most successful relationships are assertive-assertive ones.

Learn how to be both an understanding listener who looks deeply into important issues and someone who can communicate my own feelings in a direct, caring, and diplomatic manner to others.

CHECK OUT University Counseling Center Self-Instructional Videos to build Interpersonal skills in MEETING PEOPLE, DATING, ASSERTIVENESS, AND COMMUNICATION SKILLS. Hundreds have increased their meeting people, dating, and assertiveness skills with these videotapes. Ask receptionist.

ROMANCE TRAINING
Men and women often differ considerably in their knowledge and expectations about romance. One survey found that 94% of romance novels are read by women. Women gain a lot of knowledge and expectations from their reading, watching romantic movies, and talking with each other. Many men could learn more about what women want simply by going to romantic movies, reading some romantic books, or just asking women what they think is romantic. Also, anyone can buy books that give tips about how to be romantic.

Most men feel inadequate in the romance area, but won't admit it to anyone. Instead many just belittle romance as being unimportant or avoid dealing with it by saying, "I'm not the romantic type." However, anyone can add romance to their relationships. Anyone can buy cards, flowers, give compliments, be affectionate, take someone to a romantic setting, enjoy a sunset together, learn to dance, or go to romantic movies. Above all, ask your partner what he/she wants and what he/she thinks is romantic, and then be open for developing a more "romantic" outlook and actions. It can add a lot of fun and intimacy to your relationship and make you more sexually desirable.

If you want your partner to be romantic, remember that he/she may feel insecure in that area and be very sensitive to criticism. So use a positive approach as much as possible. Tell your partner how important romance is to you, be specific about what actions you think are romantic, and praise your partner for any romantic attempt (never make fun of attempts). Say, "How romantic," not "its about time you bought me some flowers."

RELATIONSHIP RESUME'

Make your own relationship resume.
(1) It will help you become aware of what you have to offer in a relationship as well as what you want from a potential partner. It may also help you identify problem areas or areas you want to develop more.
(2) You can use this as a guide to make a plan of what you want potential partners to know about you (as soon as possible) to help "sell" you to someone who has similar values and criteria for what they are looking for. These can also be useful for answering "dating ads."

For each category below, fill in aspects of yourself that relate to that category.

BIOGRAPHICAL INFORMATION
Name, age, ethnic, etc.

EDUCATION AND OCCUPATIONAL INFORMATION
Accomplishments (Education, Work Experience, etc.)

Goals (major) and why

INTEREST, FUN, RECREATION

  • Observer (TV, movies., cultural events, stereo music)
  • Active (aerobics, tennis, dancing, golf, biking)
  • Romanic (romantic walks, music candlelight, flowers, card, gifts )
  • Parlor games (Trivial Pursuit, cards)
  • Hobbies (photography, painting, computers, etc.)
  • Intellectual interests (science, history, literature, philosophy, religion, computers, psychology )

PEOPLE

  • Family (all about them)
  • Friends & social activities, interests

COMMUNICATION SKILLS & HABITS

  • intimacy (openness, honesty)
  • affectionate
  • empathetic understanding
  • assertive (friendly, fair, diplomatic)
  • desire equality vs. traditional male-female

BELIEFS and PERSONALITY FACTORS

  • honesty/integrity
  • optimism/positive attitude and point of view
  • self-esteem/confident
  • independent/self-reliant
  • cooperative
  • friendly
  • sense of humor
  • hard-working/motivated/ambitious
  • complimentary vs. critical
  • assertive vs aggressive or non-assertive
  • good emotional control
  • reliability
  • spiritual/religious values
  • material/monetary values
  • family or people-related values
  • career/education-oriented values
  • self-development values
  • giving vs self-centered
  • any addictions or bad habits

Add your own items

About the author: Dr. Tom Stevens was a licensed psychologist with over 25 years of psychotherapy experience and has rank equal to full professor at California State University, Long Beach, in the Counseling and Psychological Services Center. He is the author of the book "You Can Choose To Be Happy: Rise Above Anxiety, Anger, and Depression."

APA Reference
Staff, H. (2021, December 22). Loneliness and Fear of Rejection, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/relationships/loneliness/loneliness-and-fear-of-rejection

Last Updated: March 16, 2022

Medications For FSD

Because a woman's sexuality encompasses physical, emotional, and psychological factors, the causes of sexual dysfunction are often complex and interrelated. Medications may be used in treating certain conditions that contribute to sexual dysfunction.

The estrogen hormone as a topical ointment may increase vaginal tone and lubrication, which will decrease vulval dryness, irritation, and shrinkage (atrophy). Estrogen can increase the blood flow in the vagina, as well as reduce hot flushes and other symptoms of menopause.

Researchers are studying the role of the hormone testosterone in a woman's sexual function. It is available now by prescription in a combined formula with estrogen to treat women who have entered menopause early because of surgical removal of the uterus and ovaries (hysterectomy). Studies continue on the use of testosterone patches to treat low sexual desire in women who have had their ovaries removed. However, decreased testosterone is a less common cause of sexual dysfunction than the public might think; previous studies have not reported a benefit for most women from testosterone supplementation. (10) Also, and of importance, side effects of testosterone supplementation include acne, facial hair, liver damage, loss of hair, and deepening of the voice.

Currently no medications are approved by the U.S. Food and Drug Administration (FDA) to treat female sexual dysfunction, although several paths are being studied, including stimulation of certain molecules (receptors) in the brain and increasing blood flow to the genitals. It is still too early in the process to know whether any of these medications will prove to be effective and safe treatment options. (11)

to treat erectile dysfunction in men. Because of its success in helping men to have erections, several studies have tested sildenafil as a treatment option for women with sexual dysfunction. Early studies show an increase in blood engorgement in the female genitals after sexual stimulation. However, results are mixed on any changes in sexual arousal. Studies continue on sildenafil, which has not been approved for treatment of female sexual dysfunction. (11, 12)

Medication Choices

Currently no medications are approved by the FDA to treat female sexual dysfunction. However, the FDA has approved certain treatments for specific complications of aging. For example, prescription estrogen creams are approved to treat vaginal atrophy.

What To Think About

Some medications may decrease sexual desire. Such medications include:

  • Blood pressure medications..
  • Diabetes medications.
  • Antidepressants.
  • Tranquilizers.
  • Appetite suppressants.
  • Chemotherapy for cancer.
  • Opioids.

APA Reference
Staff, H. (2021, December 22). Medications For FSD, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/sex/female-sexual-dysfunction/medications-for-fsd

Last Updated: March 26, 2022

Can an Online Relationship Work?

Are you trying to develop an online relationship with a person? Maybe our suggestions on how to make an Internet relationship work will help.

Relationships can be hard enough but meeting someone online can in some ways be harder. Time apart and not being able to see each other can take its toll on a relationship. However, it also allows a couple to get to know each other, opening up to each other more than you might in real life.

Here's a list of suggestions:

  • Make a commitment. Make sure that you both feel the same way about your relationship. Are you seeing each other exclusively? If so, is this somebody that you one day could see relocating for? Internet relationships are difficult, so you need to make sure that you are both willing to make it work.
  • Communicate daily, even if things get busy for one of you. Taking a little time for each other every day is essential. While you don't have to spend several hours a night chatting online, some sort of communication is essential. Tell each other about your day. Involve the other person in your daily life. Make him feel as though he is a part of your life, via email, instant messaging or over the phone.
  • Do things together even if you can't physically be together. Dating when you're not physically together can be tricky so be creative. You could both watch a movie that you want to see. It'll also give you something to talk about afterward. Looking at the stars, maybe finding a constellation that you are both able to see is another idea.
  • Get a webcam. While photos are nice, sometimes all you want to do is see your loved one, face to face.
  • Make plans to see each other. Making plans is important for two reasons: time together and commitment. It gives you a chance to be a couple face to face and spend time together. However, if one of you does not ever want to make plans to visit, then you might want to consider why that is. Is the other person married? By making plans to visit, you are making a further commitment in your relationship. Be sure to remember, however, that despite how close you might be over the Internet or phone, things will be a little awkward when you first meet in person. However, your partner is just as nervous as you.

APA Reference
Staff, H. (2021, December 22). Can an Online Relationship Work?, HealthyPlace. Retrieved on 2025, April 29 from https://www.healthyplace.com/relationships/online-relationships/can-an-online-relationship-work

Last Updated: March 25, 2022