Tag: sex

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Genital Warts Can Be Difficult To Eradicate

This is the most common sexually transmitted disease. It is estimated that one per cent of adults who are sexually active have warts in the genital or anal area. In the U.S. alone, one million people will develop genital warts each year. Of these, 25 per cent will have recurrent warts. And that is frustrating for the patient and the doctor.

Genital warts are also called condylomata acuminate or venereal warts. The warts are benign and are caused by human papillomavirus (HPV). There are at least 60 types of HPV. Genotypes six and 11 are found in over 90 per cent of cases of genital warts and genotypes 16 and 18 cause cervical cancers.

The virus is transferred from person to person or from contact with something someone has touched. In women, genital warts can grow on the outside or inside of the vagina, on the cervix, in the urethra or around the anus. In men, warts can grow on the tip or shaft of the penis, on the scrotum, in the urethra or around the anus.

How do you get genital warts?

Most, but not all, genital warts are sexually transmitted. Generally speaking warts are more common amongst people whose immune system is poor. But most people who get warts are healthy and well.

How do you know you have genital warts?

Most people with genital warts have no symptoms. By the time a person is infected and by the time the warts appear may be many months or years. The good news is most of those who get infected never develop warts.

The warts are soft fleshy lumps on or near sex organs or anus. Some people have itching or burning. Warts may be hidden in the vagina or anus.

What are the implications of the disease for patients?
The lesions are benign but they do cause psychosocial distress and may affect relationships as the warts are disfiguring and can be transmitted sexually. Genital warts also increase the incidence of cancer in the genital and anal area. Practicing safe sex is important. It is advisable to use barrier protection with new sexual partners. Condoms can reduce the risk of getting genital warts but warts can spread from areas not covered by a condom. Patients who are in stable relationship may not need barrier protection because the partner is already exposed to infection by the time patient sees a doctor.

How do we manage warts?

No specific treatment is appropriate for all patients and a person will need more than one treatment to clear the warts.

Most treatment plans will achieve clearance of virus within one to six months. In 20-30 per cent of patients new warts will occur over months or even years. Patients can treat themselves with podophyllotoxin (0.5 per cent solution or 0.15 per cent cream) and imiquimod (5 per cent cream). Imiquimod is expensive and podophyllotoxin takes longer to cure the condition.

Physicians can treat warts in the office by using trichloroacetic acid or by physical removal using cryosurgery (liquid nitrogen), electrosurgery and excision or laser treatment. In my surgical practice I use electrosurgery and/or excision.

The US Food and Drug Administration (FDA) has approved a new indication for a quadrivalent recombinant vaccine (Gardasil, Merck & Company, Inc) for the prevention of genital warts caused by human papillomavirus (HPV) types 6 and 11 in boys and men aged nine through 26 years. Since the vaccine does not cover all the viruses, about 30 percent of cervical cancers and 10 percent of genital warts will not be prevented by the current vaccines.

The HPV vaccine will not have an impact on an existing infection or any consequences of infection, such as anal and genital warts and cancerous or pre-cancerous changes that you may already have. It is very important to practice safe sex with your partner.

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Does Coffee Improve Sexual Performance?

Sex has been part of our lives since Adam and Eve decided to have a cup of coffee…ok I am just kidding. Anyway, Adam and Eve did what they had to do without the necessity of having coffee or having a smoke. They just needed and an apple. Now you won’t find an apple in anybody’s bedroom or a hotel room. Instead, you find a small coffee maker.

Coffee is known to do many things. But does it improve sexual performance?

In 1990, a paper was published in the Archives of Internal Medicine looking at sexual function in people over the age of 60 in Washtenaw County, Michigan. Their study showed that estimated proportions of individuals who were sexually active were 73.8 per cent for married men and 55.8 per cent for married women.

Among unmarried men and women the proportions were 31.1 per cent and 5.3 per cent, respectively. The levels of sexual activity decreased significantly with age in both genders. The estimated proportion of married men with erectile impotence was 35.3 per cent. The authors found that consumption of at least one cup of coffee per day was significantly associated with a higher prevalence of sexual activity in women and with a higher potency rate in men.

Ok, one cup of coffee would do the trick? Then why take the blue pill? I doubt whether coffee will ever replace your Viagra, Cialis, or Levitra. But coffee should keep you awake for awhile during sexual performance if you are in a habit of dosing off before the foreplay is over.

Scientists from Southwestern University found caffeine increased the female libido in experiments on rats. The Pharmacology, Biochemistry and Behaviour journal study said the effect was caused by it stimulating the part of the brain regulating arousal. But researchers said a similar effect was only likely to be repeated in humans who do not drink coffee regularly. Well, that study does not help much.

According to a report in the Globe and Mail (February 6, 2009), psychologists at Durham University in Britain questioned 200 people about their daily caffeine intake and whether they had ever had a hallucinatory experience.

The researchers found that hard-core coffee drinkers (those who consume an average of seven cups daily) were three times more likely to report seeing things that weren’t there, hearing voices and feeling as if they were floating above their bodies. I wonder who would like to make love to a person who has had seven cups of coffee. It would be a different kind of experience….levitational love making.

Caffeine is a mild stimulant which acts on the central nervous system and some other organs of the body. It temporarily improves concentration, alertness, reasoning, intellectual effort and vigilance. A prerequisite before love making? The stimulant effects of a small amount (say one cup of coffee) take effect after 15 – 45 minutes and last normally for about four hours.

Caffeine is readily absorbed into the bloodstream and does not accumulate in the body, being rapidly metabolized and excreted. It is interesting to know that the effects of caffeine do not last so long in smokers – nicotine doubles the speed at which caffeine is broken down in the body. Alcohol has a similar effect.

In summary, caffeine is a mild stimulant which may help with your sexual performance but do not make love to a person who has had seven or more cups of coffee. If you do then you will be singing …Love is in the air….

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Sexual Activity and Mysterious Headaches

Do you get mysterious headaches with sexual activity? May be not. But for one reader of my columns this has become a significant problem.

It is estimated that patients who have headache with sexual activity account for approximately one per cent of all headache patients. It is likely that the prevalence of this headache is underestimated, since patients often feel embarrassed to report intimate details about their sexual activities.

This condition has been given many names: benign coital headache (most of the time no serious underlying cause is found), masturbatory headache, orgasmic cephalagia (as it occurs usually at or near orgasm).

Apparently, headache related to sexual activity has been recognized since the time of Hippocrates. But the first systematic descriptions of this condition appeared in medical literature in 1974. Since then primary headache associated with sexual activity has become a well defined entity.

Coital headache is usually a recurrent, benign headache and is more common in men than in women. It can occur just before, during, or immediately after orgasm. The headaches are usually dull and throbbing and last from minutes to hours. Occasionally, some patients experience a sudden, explosive headache that occurs during orgasm.

Three types of sexual headaches are recognized.

The first, the dull type, is described as a dull ache in the head and neck that intensifies as sexual excitement increases, peaking at orgasm. This type of headache is little less common than type two.

Type two, also known as vascular or explosive coital headache, is a sudden, severe, explosive headache that occurs just before or at orgasm and persists for a few minutes to 48 hours. This is the most common type of coital headache. Patients find orgasmic headache frightening, distressing and disabling.

Type three is a postural headache, resembling that of low cerebro- spinal fluid pressure that develops after coitus. This type of headache is rare.

When patients first present with coital or orgasmic headache, it is mandatory to exclude serious underlying condition like ruptured aneurysm and bleeding in the brain. When a patient presents with a new type two coital headache of sudden onset, a CT scan should be performed, and even if this is negative, a lumbar puncture should be obtained, says one research paper.

Aneurysm without rupture can present as coital headache. To pick this condition it is necessary to do an angiography and MRI of the cerebral blood vessels. Other cause for coital headache is central nervous system vasculitis.

During the acute phase of pain, usual analgesics (ibuprofen, diclofenac, acetaminophen, ASA) can be tried but are considered of limited value to relieve the pain. In 25 per cent of the patients the pain may last more than two hours and up to 24 hours. Other medications which have been tried with some success are triptans, propranolol and indomethacin.

Fortunately, the prognosis is good and in the majority of patients where no underlying pathology is identified. With time the headaches disappear without any specific treatment.

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Alcohol, Drugs, Date Rape and Unwanted Pregnancy

“The contribution of alcohol and other drugs to sexual assault has been increasingly recognized during the last 15–20 years,” says an article in the Canadian Medical Association Journal (CMAJ March, 2009). The authors report that 20.9 per cent of victims of sexual assault met the criteria for drug-facilitated sexual assault, also known as date rape.

As we know, rape occurs when sexual intercourse is non-consensual. A person forces another person to have sex against his or her will. It is not uncommon to find that drugs and alcohol are involved in the rape. Rape includes intercourse in the vagina, anus, or mouth. Rape is among the most serious crimes a person can commit. Men as well as women and children can be raped.

The person who commits rape uses violence and fear to force the person to have sex. Victims of rape are physically and emotionally traumatized. Unwanted pregnancy and infection may be some of the unfortunate outcomes.

Date rape occurs when a substance is administered to a person which lowers his or her sexual inhibition and increases the occurrence of unwanted sexual intercourse. Usually, the victim and the person who commits the crime are known to each other and have been together socially in the past.

Rape is common with an estimated lifetime risk of up to one in four for women. About 25 per cent of the 1400 women who contact the Canadian Sexual Assault Centre each year report that drugs were a factor in a rape.

The drugs used in date rape usually have no colour, smell or taste and can easily be mixed with different kinds of drinks without the victim’s knowledge.

Drugs most commonly used in date rape are alcohol, marijuana, benzodiazepines, cocaine, heroin, amphetamines, GHB (gamma hydroxybutyric acid), Rohypnol (flunitrazepam), and Ketamine (ketamine hydrochloride). This list is extensive. Most of these drugs are often metabolized and excreted before the victim even perceives that a sexual assault may have occurred. Unfortunately, this contributes to the underreporting of drug-related sexual assault.

Alcohol is involved in most of the cases of date rape. Urine samples submitted by rape victims to treatment centers across the United States within 72 hours of a suspected drug-facilitated rape, alcohol was detected in 69 per cent of the samples, marijuana in 18 per cent and cocaine in 5 per cent.

The patient requires immediate attention regarding safety, management of injuries, forensic examination, emergency contraception, prophylaxis for sexually transmitted infections and psychosocial support.

Prevention is better than cure. If you are out drinking then vigilance is the key word. Drink your beverage slowly, keep an eye on your drink when mixed and obtain a fresh one after leaving the drink unattended. Do not accept drinks from strangers.

If you think that you have been drugged and raped then go to the police station or hospital right away. Get a urine test as soon as possible. Do not douche, bathe, or change clothes before getting help. You will destroy the evidence you need to find and convict the offender.

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