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Sexuality at the End of Life


By Anne Katz RN, PhD

In the terminal stages of the cancer trajectory, sexuality is often regarded as not important by health care providers. The need or ability to participate in sexual activity may wane in the terminal stages of illness, but the need for touch, intimacy, and how one views oneself don’t necessarily wane in tandem. Individuals may in fact suffer from the absence of loving and intimate touch in the final months, weeks, or days of life.head:heart

It is often assumed that when life nears its end, individuals and couples are not concerned about sexual issues and so this is not talked about. This attitude is borne out by the paucity of information about this topic.

Communicating About Sexuality with the Terminally Ill

Attitudes of health care professionals may act as a barrier to the discussion and assessment of sexuality at the end of life.

  • We bring to our practice a set of attitudes, beliefs and knowledge that we assume applies equally to our patients.
  • We may also be uncomfortable with talking about sexuality with patients or with the idea that very ill patients and/or their partners may have sexual needs at this time.
  • Our experience during our training and practice may lead us to believe that patients at the end of life are not interested in what we commonly perceive as sexual. How often do we see a patient and their partner in bed together or in an intimate embrace?
  • We may never have seen this because the circumstances of hospitals and even hospice may be such that privacy for the couple can never be assured and so couples do not attempt to lie together.

intimacy-320x320For the patient who remains at home during the final stages of illness the scenario is not that different. Often the patient is moved to a central location, such as a family or living room in the house and no longer has privacy.

  • While this may be more convenient for providing care, it precludes the expression of sexuality, as the patient is always in view.
  • Professional and volunteer helpers are frequently in the house and there may never be a time when the patient is alone or alone with his/her partner, and so is not afforded an opportunity for sexual expression.

Health care providers may not ever talk about sexual functioning at the end of life, assuming that this does not matter at this stage of the illness trajectory.

  • This sends a very clear message to the patient and his/her partner that this is something that is either taboo or of no importance. This in turn makes it more difficult for the patient and/or partner to ask questions or bring up the topic if they think that the subject is not to be talked about.

Sexual Functioning At The End Of Life

Factors affecting sexual functioning at the end of life are essentially the same as those affecting the individual with cancer at any stage of the disease trajectory. These include:go deeper

  • Psychosocial issues such as change in roles, changes in body- and self-image, depression, anxiety, and poor communication.
  • Side effects of treatment may also alter sexual functioning; fatigue, nausea, pain, edema and scarring all play a role in how the patient feels and sees him/herself and how the partner views the patient.
  • Fear of pain may be a major factor in the cessation of sexual activity; the partner may be equally fearful of hurting the patient.

The needs of the couple

Couples may find that in the final stages of illness, emotional connection to the loved one becomes an important part of sexual expression. Verbal communication and physical touching that is non-genital may take the place of previous sexual activity.

  • Many people note that the cessation of sexual activity is one of the many losses that result from the illness, and this has a negative impact on quality of life.
  • Some partners may find it difficult to be sexual when they have taken on much of the day-to-day care of the patient and see their role as caregiver rather than lover.
  • The physical and emotional toll of providing care may be exhausting and may impact on the desire for sexual contact.
  • In addition, some partners find that as the end nears for the ill partner, they need to begin to distance themselves. Part of this may be to avoid intimate touch. This is not wrong but can make the partner feel guilty and more liable to avoid physical interactions.

Addressing sexual needs

senior intimacyCouples may need to be given permission to touch each other at this stage of the illness and health care providers may need to consciously address the physical and attitudinal barriers that prevent this from happening.

  • Privacy issues need to be dealt with. This includes encouraging patients to close their door when private time is desired and having all levels of staff respect this. A sign on the door indicating that the patient is not to be disturbed should be enough to prevent staff from walking in and all staff and visitors should abide by this.
  • Partners should be given explicit permission to lie with the patient in the bed. In an ideal world, double beds could be provided but there are obvious challenges to this in terms of moving beds into and out of rooms, and challenges also for staff who may need to move or turn patients. Kissing, stroking, massaging, and holding the patient is unlikely to cause physical harm and may actually facilitate relaxation and decrease pain.
  • The partner may also be encouraged to participate in the routine care of the patient. Assisting in bathing and applying body lotion may be a non-threatening way of encouraging touch when there is fear of hurting the patient.

Specific strategies for couples who want to continue their usual sexual activities can be suggested depending on what physical or emotional barriers exist. Giving a patient permission to think about their self as sexual in the face of terminal illness is the first step. Offering the patient/couple the opportunity to discuss sexual concerns or needs validates their feelings and may normalize their experience, which in itself may bring comfort.

More specific strategies for symptoms include the following suggestions. senior lesbians

  • Timing of analgesia may need to altered to maximize pain relief and avoid sedation when the couple wants to be sexual. Narcotics, however, can interfere with arousal which may be counterproductive.
  • Fatigue is a common experience in the end stages of cancer and couples/individuals can be encouraged to set realistic goals for what is possible, and to try to use the time of day when they are most rested to be sexual either alone or with their partner.
  • Using a bronchodilator or inhaler before sexual activity may be helpful for patients who are short of breath. Using additional pillows or wedges will allow the patient to be more upright and make breathing easier.
  • Couples may find information about alternative positions for sexual activity very useful.
  • Incontinence or the presence of an indwelling catheter may represent a loss of control and dignity and may be seen as an insurmountable barrier to genital touching.

footprints-leftIt is important to emphasize that there is no right or wrong way of being sexual in the face of terminal illness; whatever the couple or individual chooses to do is appropriate and right for them. It is also not uncommon for couples to find that impending death draws them much closer and they are able to express themselves in ways that they had not for many years.

Complete Article HERE!

Family History and Addiction Risk: What You Need to Know to Beat the Odds


You grew up in a family of substance users. You know that your risk for developing an addiction to drugs or alcohol is greater because of this hereditary factor. But what exactly are your risks? And is there anything you can do to reduce your risk?

According to the National Council on Alcoholism and Drug Dependence (NCADD), the single most reliable indicator for risk of future alcohol or drug dependence is family history. In an article written for NCADD, Robert Morse, MD, former Director of Addictive Disorders Services at the Mayo Clinic and member of NCADD’s Medical/Scientific Committee, says, “Research has shown conclusively that family history of alcoholism or drug addiction is in part genetic and not just the result of the family environment…millions of Americans are living proof. Plain and simple, alcoholism and drug dependence run in families.”

How Family History Affects your Chances for Addiction

Family history affects your chances of addiction in many ways. Genes are one important factor. But alcoholism and drug addiction are “genetically complex.”

Recent research has identified numerous genes, and variations within these genes, that are 005associated with the addictive process. One way genes affect a person’s risk for addiction involves how genes metabolize alcohol. Another is how nerve cells signal one another and regulate their activity. Such changes in genes can be passed down from one generation to another.

Perhaps the strongest evidence for heredity’s role in addiction comes from twin studies and adoption studies. Studies of twins found a 60% rate of similarity regarding addiction in identical twins vs. a 39% rate of similarity in fraternal twins. Studies of children adopted in infancy and studied for addiction risk in adulthood found that biological sons of alcoholics were four times more likely to become alcoholics, even when the adoptive parent had no issues with addiction, so the l factor of family environment was minimal.

But genetic predispositions are not the only factor in predicting the role of family history in addiction risk. Environmental aspects also play a role, even though they may be less significant in some cases.

Researchers have identified several family-related risks for increased vulnerability:

  • Family dysfunction (conflicts or aggression)
  • A parent who is depressed or has other psychological issues
  • One or more parents who abuses or is addicted to drugs or alcohol

Additional social and personal issues that contribute to risk include:

  • Limited social skills
  • Fragile self-esteem
  • Minimal or no support system
  • Personal history of impulsivity, aggression or difficulty managing emotions
  • A history of trauma or abuse (high risk for post traumatic stress)
  • Other psychiatric disorders such as depression, anxiety or bi-polar disorder
  • Friends or acquaintances who are regular users and who provide easy access to drugs or alcohol

Addressing and Reducing Risks

An alternative viewpoint regarding a family history link for addiction comes from a National Institute of Health (NIH) meta-study of 65 published papers documenting 766 study participants who were college or university students. Controlling for alcohol consumption and use disorders, family history was reviewed as the variable. The meta-study found that students who had family histories of alcohol or drug problems did not drink more but they were likely to be more at risk for problems that are associated with drug or alcohol use (ex: causing shame or embarrassment to someone; passing out or fainting; or having problems with school).

The bottom line is that there are still a lot of uncertainties when it comes to assessing drug and alcohol risks as they relate to family history. The good news is that even if you come from a family with a troubled history, or a history of addictions, that does not mean you will automatically become an addict. The risk is higher, but there are ways to prevent that from happening. You can choose to be proactive and greatly reduce your addiction risk.

Here are a few suggestions to reduce your addiction risk:

  • Avoid under-age drinking or substance use; early-onset of use increases risk
  • Choose abstinence or carefully monitor your consumption
  • Avoid associating with heavy drinkers or substance users
  • Manage your psychological health; seek assistance from a mental health provider if you are highly stressed, anxious or depressed
  • Participate in workplace or school prevention programs

Intervention Strategies

Should you already find yourself dealing with an alcohol or drug issue, here are some intervention strategies provided by the National Institute of Health, in their publication, Alcohol Alert:

  • Motivational Interview: This strategy focuses on enhancing your motivation and commitment to changing your behavior, if you are currently abusing drugs or alcohol. Typically you would work with an addictions counselor or mental health professional and discuss your beliefs, choices and behaviors associated with substance use. The purpose of the interview is to help you develop a realistic view of your use, problems associated with it and your treatment goals and expectations.
  • Cognitive–Behavioral Interventions: These strategies are taught by a counselor or therapist, or they can sometimes can be accessed via an online self-help program. They help you change your behavior by helping you recognize when and why you drink excessively or use illegal substances. Cognitive-behavioral approaches challenge irrational expectations about substance use and raise your awareness of how drugs or alcohol affect your health and well-being. They provide tools for mentally and emotionally addressing denial, resistance, self-criticism and shame.
  • Drug-Free Workplace programs: Many workplaces now help their employees who are abusing alcohol or drugs. Lifestyle campaigns encourage workers to ease stress, improve nutrition and exercise, and reduce risky behaviors such as drinking, smoking, or drug use. Other programs promote social support and volunteerism. Many Employee Assistance Programs offer employees referrals to substance abuse or other treatment programs, and may help pay for treatment.

Remember, the risk for alcohol and drug addiction does run in families. But you can manage the risk and avoid an addiction problem in your own life. Be proactive in monitoring your substance use, manage your mental and emotional health and seek support if you need it. The final outcome will depend on you and the choices you make today, not on your history.
Complete Article HERE!

This Is How Guys’ Junk Stacks Up Against Each Other

By and

Will Varner / BuzzFeed

Over 150,000 readers took our very unscientific, informal poll that, which asked people with a penis what their habits with their beefcake are…

Nothing was off limits with questions ranging from size, shape, maintenance, and even insecurities people have.

These were some of the most popular results:

Most guys consider their dick size…average. Specifically, 66% of those polled or 75,000 people say they’re between 4-6 inches.

Most guys consider their dick size...average. Specifically, 66% of those polled or 75,000 people say they're between 4-6 inches.

Will Varner / BuzzFeed

68% of pollers answered that they’re growers not showers. Specifically, 69,400 people said they only get big when it’s time for action.

68% of pollers answered that they're growers not showers. Specifically, 69,400 people said they only get big when it's time for action.

Will Varner / BuzzFeed

Manscaping is a thing: 38% of people said they keep it trimmed down there because it looks good. But, 28% of people keep it very tidy, with little to no hair. And, 26% said they just live and let live down there.

Manscaping is a thing: 38% of people said they keep it trimmed down there because it looks good. But, 28% of people keep it very tidy, with little to no hair. And, 26% said they just live and let live down there.

Will Varner / BuzzFeed

55% of pollers admitted to being circumcised, 34% said they were not, and 11% of responders admitted that they are circumcised but they’re not OK with the choice their parents made for them.

55% of pollers admitted to being circumcised, 34% said they were not, and 11% of responders admitted that they are circumcised but they're not OK with the choice their parents made for them.

Will Varner / BuzzFeed

Dick pics aren’t as prevalent as the Internet would have us believe. 49% of responders said they’d rather show their member in-person than actually send a dick pic. But, 22% say they’d happily oblige if asked.

The Results Are In, This Is How Guys' Junk Stacks Up Against Each Other

Will Varner / BuzzFeed

Breathe easy because 66% of people say one testicle definitely hangs lower than the other. But if you’re not made that way don’t worry because 24% say that they’re pretty even.

Breathe easy because 66% of people say one testicle definitely hangs lower than the other. But if you're not made that way don't worry because 24% say that they're pretty even.

Will Varner / BuzzFeed

32% of responders say they’ve seen their friends penises and it’s not a big deal at all.

32% of responders say they've seen their friends penises and it's not a big deal at all.

Will Varner / BuzzFeed

40% of people say they’ve never tasted their cum before…but 36% say they have and 24% said maybe. Yum!

40% of people say they've never tasted their cum before...but 36% say they have and 24% said maybe. Yum!

Will Varner / BuzzFeed

When reaching the “big O” 27% of people say that when they shoot it hits their chest. 26% say it’s definitely a lot that cums out. But if you’re not in that boat, don’t worry because, 24% of people say the fluid just kind of just oozes out.

The Results Are In, This Is How Guys' Junk Stacks Up Against Each Other

Will Varner / BuzzFeed

Complete Article HERE!

Pride Goeth Before The Fall

Name: Jen
Gender: female
Age: 59
Location: North Dakota

I’m a widow and I am so sad. The fellow I’m going with, I really love him, but I can’t have an orgasm with him. I was able to have an orgasm with my husband who is passed away. And I can when I am playing with a toy by myself.

He has such pride and I don’t want to hurt his feelings, because it would take me about a half hour of foreplay to get there.

Thank you for your message, Jen. Your concern about your man and his inability to rock your world is, sadly, a very familiar complaint. I hear it from women all the time.pride

You say that your man is prideful and that you don’t want to hurt his feelings. But are you really willing to sacrifice your sexual wellbeing on that altar? I hope not. Even prideful men can learn something about pleasuring the woman they are with.

Let’s just say that this guy your dating knew how to pleasure all the women he has ever been with previous to you. That pedigree doesn’t make him an expert on pleasuring every other women he will meet, and that includes you.

Allow me to share with you the exchange I had with another woman in your situation. Perhaps my advice to her will be helpful to you. This is from…

Name: Zoe
Gender: female
Age: 25
Location: Boise
I learned how to masturbate when I was 12. From that first time I’ve loved how it makes me feel. No matter how good my lovers are; they never come close to the pleasure I feel when I’m touching myself. I like the intimacy I have with my boyfriend, but he’s not very good in the sack. I’ve been trying to get him to watch me masturbate, or we could masturbate together, so that he’d know how to touch me and make the bells ring. Unfortunately, he’s really straight-laced and he thinks my suggestion is perverted. He resists every time I bring it up. Sometimes after we have sex, I wait for him to fall asleep then get myself off. Is this selfish?


You betcha it’s selfish, selfish as all get-out. Not you, Zoe, but the bonehead you’re fuckin’. This is a classic, “you can lead the horse to water, but you can’t make him drink” sorta deal. Only here we have a “you can lead the horse’s ass to the mysteries of pussy, but you can’t make him appreciate them.”

I gotta ask, what makes a sexually enlightened chick like you hook up with and stay with bozo like him? Do you actually think that he’s gonna magically come around one fine day and let you lead him to nirvana? I think not. You know why I think this? It’s because you’ve created a monster — an “all I need to worry about is me gettin’ off in my girlfriend’s snatch” kinda monster. And that’s one scary kinda monster.

I am of the mind that it’s fruitless to try to get an obstinate partner, like your guy to do something he doesn’t want to do. The nagging alone will harden his resolve to resist. This does not mean you’ll never get your way. It just means that you have to go about this in a completely different way than, “oh honey, won’t you please cum and watch me jill-off? In the numbskull’s defense, he may be missing the point completely. He may not understand why you want him to watch you pleasure yourself. So if your agenda is to get him to be a better lover, that’s how you’re gonna have to approach the big lug.

First off, he needs to be told, in no uncertain terms, that he’s not the Hercules in the boudoir he thinks he is. This is gonna sting his ego like crazy and it might very well be the end of him and you altogether. But I assure you, risking this is much better than maintaining the status quo. Because, with each passing fuck, he will be more convinced then the fuck before that he’s da man.im_da_man

Once you burst his bubble, you’ll need to immediately inflate a new one for and with him. Us men folk can’t live very long with out our illusions. Begin this inflation process by taking some responsibility for this predicament. Own up to keeping him in the dark about his lack of sexual prowess. Then tell him that there’s a very easy and fun fix for the problem. Maybe if he understands that you want to jill-off for him as a tutorial, he’d be more compliant.

I’d be willing to guess that if you made this presentation more of a game or a role-play scenario then a seminar he’d be more receptive. Why not try something like this. Introduce a blindfold into your sex play. Have him strip down to his jock for you, then blindfold him. It’s gonna be his job to get you off without using the magic wand he has stuck in his jock. The blindfold will necessitate that he use his hands (and mouth) to find and pleasure you. While you tease his dick inside his jock guide his hands to your pussy. He’ll no doubt be fumbling around at first, so you’ll have to encourage him with some dirty talk, or actually use his hand to jill yourself off. Just remember keep it fun and playful and keep his dick safely tucked away.

You can see how this little exercise could be educational for him without being emasculating. Once he figures out that there’s more to sex than the old in and out, he might actually cum around, so to speak. Similarly, you might, on another occasion, submit to the blindfold yourself and have him use your hand to jack himself off. In time, you be able to do away with the blindfold altogether. But then, you might want to introduce restraints of some sort. While he’s buck naked and restrained put on a hot and horny show for him. Tease him with your self-pleasuring, but don’t let him touch you. Maybe rub yourself with his stiff cock. Since he’ll be unable to resist, it will be like masturbating with his pecker. Doesn’t that sound like a load of fun for all concerned?

Good luck

The Yin and Yang of Desire

Today I’d like to talk about: The Yin and Yang of Desire — Dopamine, Prolactin and Testosterone.

Let’s talk about love, lust and desire. But instead of looking at these things as social phenomena, let’s look at the chemical reactions going on inside our bodies that make us feel and behave the way we do.

sex-on-the-brainThere are clear links between certain chemicals and our most basic drives, which explains, for example, why we feel horny one moment and utterly disinterested the next. Or why our sex drive peaks after exercise. At the core of our sexual and affectional interests and behaviors lie the two chemicals — dopamine and prolactin. In many ways they are complimentary to one another; dopamine turns on desire and prolactin turns it off.

Dopamine is a neurotransmitter. This is basically your body’s pleasure and reward system. Our brains releases dopamine, to one degree or another, when we see, read or think about something sexy, taste something sweet, puff a cigarette, or come into skin-to-skin contact with another person. When dopamine levels are high, our libido goes into overdrive. Sometimes levels can be so dramatic that a person will neglect other essential bodily functions like eating and sleeping. Some “street” drugs —meth and coke among them — can mimic the body into thinking it’s dealing with dopamine.

Dopamine is critical to the way the brain controls our movements. If there’s not enough dopamine, we can’t move, or control our movements. If there’s too much dopamine, we are plagued with repetitive moments like jerking, tapping and twitching.

Get this; novel situations can increase dopamine releases. For example, hooking up with someone for the first time triggers especially high levels of dopamine. Curiously enough, these same high levels will not occur again during subsequent hookups with that same person. This is called the one-night-stand phenomenon; it’s why you can be attracted to someone at first encounter but not afterward.hormones and the brain

However, falling in love with someone can sustain high dopamine levels for a longer period of time. This explains why physical infatuation is at its peak in the beginning months of a relationship. Also dopamine floods the brain when we get drunk or take certain drugs, which is why drinking alcohol can make a potential partner look more attractive.

Prolactin is dopamine’s foil. It causes dopamine levels to plummet. Prolactin is a hormone, as opposed to a neurotransmitter, like dopamine. It floods the body during orgasm, virtually shutting down the sex drive, which is nature’s way of allowing us to attend to other essential bodily functions like eating and sleeping. Prolactin release in men will temporarily disable our ability to have an erection. This is called the refractory or recovery phase of our sexual response cycle. And prolactin is at least partially responsible for that happy, relaxed state after we cum. This is precisely the release women get while breastfeeding; in fact, the word “pro-lactin” directly indicates its role in milk production.

growing larger and largerProlactin primes the mind for long-term attachment — a role that helps the mother bond with her suckling child as well as lovers to each other. This means that if you stick around cuddling with your partner right after sex, you may actually start to like him/her more and more. This is called the pair-bonding effect. But prolactin’s dopamine-reducing action has a darker side. It cancels the tolerance you may have for your partner’s flaws.

While dopamine and prolactin are good indicators of the immediate workings of sexual pursuit, it is testosterone that best explains long-term changes in courtship. Testosterone is responsible for the masculinization of the adolescent male body during puberty. And it increases the dopamine levels that regulate our sex drive. But testosterone leaves its fingerprint on the body as much as the brain. It’s the catalyst for changes in skin tone, fat distribution, musculature and demeanor, which are signals to others that this individual male is sexually mature and in good health.

However, if you get a fever or become depressed, your testosterone levels can drop significantly. Malnutrition or high levels of anxiety or stress will also interfere with testosterone levels. The most immediate effect of this is a decrease in libido, and a noticeable drop-off in energy levels as well as confidence. There’s no doubt about it; testosterone levels will signal to potential mates that you are in the throws of depression, stress, anxiety or malnutrition. You will appear a little less attractive to people subconsciously. That’s why a confident, dominant male with high-testosterone levels generally enjoy more mating success.tits

Testosterone levels are highest in the morning, then wanes throughout the day. It’s also much higher in men in autumn and lowest in the spring.

However, sexual desire is still more complicated than is known to science, and there may be multiple archetypes of partners we’re drawn to — there is evidence that aggressive high-testosterone men appear sexier to women and gay men for a one-night stand. But softer, more sensitive balanced men are more likely to tug at our heartstrings in a relationship. Scientists reason that the bulkier mate is more likely to be physically powerful and carry good genes to create strong children. While the slimmer guy is a more loving, reliable partner likely to help raise the kids so they survive to adulthood. The effect of this strange contradiction seems to be a biological predisposition against monogamy and sexual exclusivity.

But none of this is carved in stone. A man’s hormone’s levels increase when he is in a competitive environment or carries out acts of aggression, which can explain how guys seem to bulk up quickly when they go to prison or join sports teams. These levels decrease when he feels intimidated or humiliated, which might explain why those who get picked on at school stay skinny and mild-mannered compared to their peers. This in turn made them easier targets and only increased the likelihood of them being bullied.

butt shakeThis is not uncommon behavior among primate colonies that have huge alpha males looming over a population of smaller, submissive males and females. While this is not a perfect parallel to human social groups, it does go a long way in explaining how a social environment can be a precursor to physical body changes. And just so you know, our testosterone levels also drop during long-term relationships, giving the male brain a sense of stability and mellowness, easing off the drive to forage for new sexual partners.

Science alone lacks a moral element, and fails to explain, in a modern context, why we should desire to be masculine, aggressive, potent or dominant in the first place. In nature, the alpha-male is the most likely to enjoy reproductive success, but that isn’t what gives our lives value today. We might have more success being an average male that falls in love and becomes a good provider. And in the modern world it’s probably the more stable and sensitive man who is most likely to sire children.

Still, science gives important clues to what’s going on in our minds and bodies and that of our potential partners. A lot of our basic inclinations are out of our control, but when we know what causes them or what to expect, we can work with them for the best outcome.

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