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Sexuality and Illness – Breaking the Silence


(This is a Companion piece to yesterday’s posting. You’ll find yesterday’s posting HERE!)

By: Anne Katz PhD

Sexuality is much more than having sex even though many people think only about sexual intercourse when they hear the word. Sexuality is sometimes equated with intimacy, but in reality, sexuality is just one way that we connect with a spouse or partner we love (the true meaning of intimacy). Our sexuality encompasses how we see ourselves as men and women, who we are attracted to emotionally and physically, what turns us on (eroticism), our thoughts and fantasies, and yes, also what we do when we are sexually active, either alone or with a partner. Our sexuality is connected to our image of ourselves and it changes over the years as we age and face threats from illness and disability and, eventually, the end of life.seniors_men

Am I still a sexual being?

Illness can affect our sexuality in many different ways. The side effects of treatments for many diseases, including cancer, can cause fatigue. This is often identified as the number one obstacle to sexual activity. Other symptoms of illness such as pain can also affect our interest in being sexually active. But there are other perhaps more subtle issues that impact how we feel about ourselves and, in turn, our desire to be sexual with a partner or alone, or if we even see ourselves as sexual beings. Think about surgery that removes a part of the body that identifies us as female or male. Many women state that after breast cancer and removal of a breast (mastectomy), they no longer feel like a woman; this affects their willingness to appear naked in front of a partner. Medications taken to control advanced prostate cancer can decrease a man’s sexual desire. Men in this situation often forget to express their love for their partner in a physical way, no longer touching them, kissing them, or even holding hands. This loss of physical contact often results in two lonely people.  Humans have a basic need for touch; without that connection, we can end up feeling very lonely.

Just talk about it!

seniors_in_bedCommunication lies at the heart of sexuality. Talk to your partner about what you are feeling, how you feel about your body, and what you want in terms of touch. Ask how you can meet your partner’s needs for touch and affection. The most important thing you can do is to express yourself in words. Non-verbal communication and not talking are open to misinterpretation and can lead to hurt feelings. Our sexuality changes with age and time and illness; we may not feel the same way about our bodies or our partner’s body that we did 20, 30 or more years ago. That does not mean we feel worse – with age comes acceptance for many of us – but we do need to let go of what was, and look at what is and what is possible.

The role of health care providers

Health care providers should be asking about changes to sexuality because of illness or treatment, but they often don’t. They may be reluctant to bring up what they see as a sensitive topic and think that if it’s important to the patient, then he or she will ask about it. This is not good. Patients often wait to see if their health care provider asks about something and if they don’t, they think that it’s not important. This results in a silence and leaves the impression that sexuality is a taboo topic.senior intimacy02

Some health care providers are afraid that they won’t know the answer to a question about sexuality because nursing and medical schools don’t provide much in the way of education on this topic. And some health care providers appear to be too busy to talk about the more emotional aspects of living with illness. This is a great pity as sexuality is important to all of us – patients, partners, health care providers. It’s an important aspect of quality of life from adolescence to old age, in health and at the end of life when touch and love are so important.

Ask for a referral

If you want to talk about this, just do it! Tell your health care provider that you want to talk about changes in your body or your relationship or your sex life! Ask for a referral to a counselor or sexuality counselor or therapist or social worker. It may take a bit of work to get the help you need, but there is help.

Complete Article HERE!

The extraordinary case of the Guevedoces

Catherine and his cousin Carla, Guevedoces in the Dominican Republic

Catherine and his cousin Carla, Guevedoces in the Dominican Republic

The discovery of a small community in the Dominican Republic, where some males are born looking like girls and only grow penises at puberty, has led to the development of a blockbuster drug that has helped millions of people, writes Michael Mosley.

Johnny lives in a small town in the Dominican Republic where he, and others like him, are known as “Guevedoces”, which effectively translates as “penis at twelve”.

We came across Johnny when we were filming for a new BBC Two series Countdown to Life, which looks at how we develop in the womb and how those changes, normal and abnormal, impact us later in life.

Like the other Guevedoces, Johnny was brought up as a girl because he had no visible testes or penis and what appeared to be a vagina. It is only when he approached puberty that his penis grew and testicles descended.

Johnny, once known as Felicita, remembers going to school in a little red dress, though he says he was never happy doing girl things.

“I never liked to dress as a girl and when they bought me toys for girls I never bothered playing with them – when I saw a group of boys I would stop to play ball with them.”

When he became obviously male he was taunted at school, and responded with his fists.

“They used to say I was a devil, nasty things, bad words and I had no choice but to fight them because they were crossing the line.”

We also filmed with Carla, who at the seven is on the brink of changing into Carlos. His mother has seen the change coming for quite a while.

“When she turned five I noticed that whenever she saw one of her male friends she wanted to fight with him. Her muscles and chest began growing. You could see she was going to be a boy. I love her however she is. Girl or boy, it makes no difference.”

Child on swing



So why does it happen? Well, one of the first people to study this unusual condition was Dr Julianne Imperato-McGinley, from Cornell Medical College in New York. In the 1970s she made her way to this remote part of the Dominican Republic, drawn by extraordinary reports of girls turning into boys.

When she got there she found the rumours were true. She did lots of studies on the Guevedoces (including what must have been rather painful biopsies of their testicles) before finally unravelling the mystery of what was going on.

When you are conceived you normally have a pair of X chromosomes if you are to become a girl and a set of XY chromosomes if you are destined to be male.

For the first weeks of life in womb you are neither, though in both sexes nipples start to grow.

Then, around eight weeks after conception, the sex hormones kick in. If you’re genetically male the Y chromosome instructs your gonads to become testicles and sends testosterone to a structure called the tubercle, where it is converted into a more potent hormone called dihydro-testosterone This in turn transforms the tubercle into a penis. If you’re female and you don’t make dihydro-testosterone then your tubercle becomes a clitoris.

Foetus at 12 weeks

When Imperato-McGinley investigated the Guevedoces she discovered the reason they don’t have male genitalia when they are born is because they are deficient in an enzyme called 5-alpha-reductase, which normally converts testosterone into dihydro-testosterone.

This deficiency seems to be a genetic condition, quite common in this part of the Dominican Republic, but vanishingly rare elsewhere. So the boys, despite having an XY chromosome, appear female when they are born. At puberty, like other boys, they get a second surge of testosterone. This time the body does respond and they sprout muscles, testes and a penis.

Imperato-McGinley’s thorough medical investigations showed that in most cases their new, male equipment seems to work fine and that most Guevedoces live out their lives as men, though some go through an operation and remain female.

Another thing that Imperato-McGinley discovered, which would have profound implications for many men around the world, was that the Guevedoces tend to have small prostates.

This observation, made in 1974, was picked up by Roy Vagelos, head of research at the multinational pharmaceutical giant, Merck. He thought this was extremely interesting and set in progress research which led to the development of what has become a best-selling drug, finasteride, which blocks the action of 5-alpha-reductase, mimicking the lack of dihydro-testosterone seen in the Guevedoces.

My wife, who is a GP, routinely prescribes finasteride as it is an effective way to treat benign enlargement of the prostate, a real curse for many men as they get older. Finasteride is also used to treat male pattern baldness.

A final interesting observation that Imperato-McGinley made was that these boys, despite being brought up as girls, almost all showed strong heterosexual preferences. She concluded in her seminal paper that hormones in the womb matter more than rearing when it comes to your sexual orientation.

This is still a controversial topic and one I explore later in the film when I meet Mati, who decided from the earliest age that though “he” looked like a boy, Mati was really a girl.

As for Johnny, since he developed male genitalia he has had a number of short term girlfriends, but he is still looking for love. “I’d like to get married and have children, a partner who will stand by me through good and bad,” he sighs wistfully.

Complete Article HERE!

You’re Pulling My Leg

Name: Jerry
Gender: Male
Age: 60
Location: Minnesota
I have a fixation with prostate stimulation. I have recently been giving myself perineum injections to the prostate with 2/3 xylocaine and 1/3 sodium cloride. The xylocaine is 2% with ephinepherine. I am careful to clean the injection site – just above the anus and use a 1 1/2 inch 25 guage needle injecting 3 ml. The feeling is fantastic when I hit the prostate. I actually feel the nerves take the anesthetic. I am careful to always make sure I do not hit a blood vessel before injecting by pulling back on the plunger. Is this fetish common? What dangers to you think are there? I find this a real turn on. I also have done many intra-rectal injections to the prostate but only use sodium chloride (salt water) as I cannot see the syringe to tell if I am injecting in a blood vessel. This requires careful cleaning of the anus but have never had any problems except very rarely giving myself an urethral infection.

You have got to be kidding! I mean really, Jerry! You want to know if this is a common fetish? Ahh, no, I’d have to say not all that much.hypodermic-needle

So I’m sitting here trying to imagine how you go about doing these alleged injections. What kind of physical position must you have to assume to see, and than land the alleged hypodermic needle on just the right spot on your taint (perineum) so that you hit your prostate? I suppose you allegedly do this with a mirror, right? But even then there’s plenty room for error, right?

It sounds like you been doing this alleged needle play for a while? I have to wonder, how in the world did you happen upon allegedly shoot up anesthetics right into your prostate? And where are you getting these alleged anesthetics, I wonder?

Everything about your story makes me very suspicious as to the authenticity of your reporting. If indeed you are doing precisely what you tell me, allow me to advise you to reconsider your actions. I don’t think this is a healthy pursuit for any number of reasons. And I suspect that you also have your qualms. I mean, why else would you ask me about potential dangers.not-a-golfer-cartoon

If you are experiencing periodic infections that tells me you’re not taking care of business properly. I’m gonna guess that you’re not properly attending to sterilizing the medical equipment you are using. And if your anesthetics are coming from a dubious source, well then anything can happen.

I’m guessing you have too much time on your hands, sir. Maybe you should take up golf.

Good luck

A Boy’s Own Story

What follows is an exchange I had recently with a young Catholic Canadian man.

Hi Dr. Wagner

My Name is Jack, I am a catholic teenager who is wondering if the act of masturbation is still considered to be a sin. Also is it really considered to be gravely disordered and always morally wrong? I am 18 years old and I am somewhat late going through changes physically. I do believe that it is a natural way to find out about ones body and how it can be used. I have heard that it is not a sin but a natural and healthy thing to do. I have also heard that it is a sin. I have heard mixed reviews I have heard that a vast majority of both boys and girls do it. I can understand if one does it while thinking about other people then it is a sin but if one is doing it to get rid of old stuff then does it count as a sin. I have done it recently and I am going through puberty. There are no thoughts, images or fantasies involved. I do think that it is better then having a nocturnal emission and having to clean your underpants and to hide it so no one think that I wet the bed. I also believe that it is better to masturbate rather than waking up to find a sticky mess in my underpants, which has happened to me, and it was not fun. I don’t want to have to go to bed worrying about a mess in the morning. I have also heard that it can help reduce the risk of prostate cancer. Is it normal to feel confused about it after doing it? I am planning to talk to my parents and a priest to see what they think of it. If my parents say that it is natural and a normal thing to do does that mean it is all right to do. The only tricky thing is that I am not entirely sure how to approach the subject with them. I have mentioned it to my mother and she doesn’t seem to be bothered by it. She said that it is better to do that than to be out having intercourse with girls. I haven t done it in 3 weeks and I feel conflicted over it I see both views on the issue and I am not sure. I don’t want to feel guilty for doing something that has been labeled natural and normal. I love and believe in god and want to know what the views are on it. I do not have any addiction whatsoever I have very good control over myself nor do I need counseling or therapy. I am just a curious teenager wondering if masturbating is a sin or not.

I live in Ontario where the ministry of education has released a updated sexual education curriculum where it mentions that masturbation is natural and normal. There is a part of me that really wants to do it as I feel it takes the edge off. I have heard that some catholic organizations are backing it. This leaves me confused if it is still considered to be a sin. I also believe that it is a crucial part of understanding how ones body works and learning about oneself. I do find it a little hard to understand that we can somewhat accept the sexual orientation of people but people still consider touching ones genitals to be a sin.

Thank you
God Bless

Dear Jack,

Thanks for your question. Might I add, you are exceptionally articulate for a teenager.a boy's own story

If ya ask me, Jack, and you are actually asking me, you’ve pretty much answered all of your own questions. And that tells me you are on the right track.

You ask about Catholic sexual ethics. Before you wrote, did you know that I was a Catholic priest for 20 years? And, not to boast, I am the only Catholic priest in the world with a doctorate in human sexuality. This later part explains why I no longer practice as a public minister. It’s a real long story and I’d be happy to tell you all about it sometime, but for now know that I didn’t go quietly. I wrote my doctoral thesis, Gay Catholic Priests; A Study of Cognitive and Affective Dissonance, back in 1981. And once word got out about this groundbreaking research, the writing was on the wall, so to speak, for my public ministry. I fought for my priesthood and ministry for 13 year, but it all pretty much came crashing in on itself in 1994. If you’ve got nothing better to do, you can read about it HERE.

Enough about me, let’s get back to you and your questions. Although, I wanted to mention that when I was in seminary, way back when god was young, in the late 1960’s and early 70’s, enlightened spiritual directors were already beginning to advise us seminarians that masturbation wasn’t sinful or disordered. Of course, even now you’ll find orthodox hard-liners who insist that self-pleasuring is a moral sin, but they think all sexual expression is sinful. Here’s a tip: you’re never gonna find consensus on any sexual matter.

Like you, I found it difficult to believe all that mortal sin stuff that the hardliners promote. I mean, if mass murder and genocide are mortal sins, how could a little wank be their equal. It just don’t make no sense, right?

However, I can’t agree with you that masturbation might be sinful if there are fantasies involved. Remember, using your mind is an essential part of learning about your sexuality. That being said, most teenage boys are randy at the drop of a hat, so maybe you don’t need to be all that specific with your sexual mental imagery.

I also caution you to be careful when tossing around words like normal and natural. What’s normal and natural to some may be abnormal and twisted to others. But you’re right; few people, professional as well as lay people, these days would consider self-loving anything but normal and natural.

For you edification I suggest you use the search function or CATEGORY pull-down menu in the sidebar of my site and search for pertinent topics, like masturbation, wet dreams, sexual response cycle, etc. You’ll find a wealth of information about all these topics in both written and podcast form.

the shadowI too reported, back in 2011, on the startling new data that came out of Australia about masturbation. Australian researchers questioned over 1,000 men who had developed prostate cancer and 1,250 men who had not, about their sexual habits. They found those who had ejaculated the most between the ages of 20 and 50 were the least likely to develop prostate cancer. The protective effect of poppin’ one’s nut was greatest while the men were in their 20s. And get this; men who ejaculated more than five times a week were a third less likely to develop prostate cancer later in life.

I also contend that masturbation is the most basic building block to all of our sexual expression. When you know how your body works; when you are familiar with your sexual response cycle and are confident about talking to others about it; you’ll be better situated to be a good sexual partner to another.

In the end, I encourage you to continue to think for yourself when it comes to things sexual. I can see that you are already doing that, so keep it up. Continue to ask questions and consider the input you get from others, myself included; but then make up your own mind. When you own your sexuality and your sexual response, you’ll be a grown-up. Notice I didn’t say you’d be an adult. That’s because there are lots of adults out there who don’t own their sexuality and sexual response and despite being grown up, they’re not grownups.

Good luck, pup

Hi Richard,
Thank you for responding. You have cleared come of the confusion. I guess I got confused because when I would masturbate I would feel like I let my self down.
Thank you again
God Bless

One thing you should know is there is generally a sort of “let down” phase after orgasm. (See information about the refractory phase of the sexual response cycle HERE.) Your body can’t stay in that heightened state of arousal so there’s often a “deflated” feeling.

There’s even a name for if. It’s called post-coital tristesse. And you should know that it’s a physiological phenomenon rather than an emotional one.

Feelings of elation and wellbeing that accompany arousal and orgasm can sometimes morph into a sense of shame during this “deflated” phase. People with lot of scruples about sex are particularly vulnerable to this.

Thank you for clearing that up and for the reassurance that it is natural and normal and not considered to be a sin.
— Jack

Wonderful World of Butt Plugs!

I’m really curious how you actually overcome the fascination of wanting anal sex? What do you do and what does it take?

Ahhh, your pullin my leg, right? Cassandra, darling, I don’t get it. You have a fascination with wanting some hot backdoor action; is that correct? Am I supposed to gather from this rather round about way of putting things that you have yet to explore ass fucking? That’s what it sounds like to me.

i'm wearing my butt plugIf I’m correct in this assumption, the sure-fire way of overcoming this or any fascination of wanting this or anything else is to indulge yourself the very thing you’ve been wanting. This is not rocket science.

Once you have a taste of what you’ve desired, you’ll no longer need to overcome a fascination. If by chance, you’re actually wondering if you want to enjoy your butthole or not and you want to discover this on your own without the pressure of having a partner present; then I suggest you do a little experimentation on your own.

Allow me to introduce you to the Wonderful World of Butt Plugs! Not sure what a butt plug is or why you would want one? Or maybe you sure enough know a butt plug from a hole in your head, but you just don’t know how to go about choosing the right one for you. Well, never fear, because Dr Dick is here with another one of his Handy Dandy Sex Toy Advisories: Plug Your Hole In Three Easy Steps. And you can thank all my inquisitive correspondents and the treasure trove that is Dr Dick’s Stockroom for the heads up on these puppies.

A butt plug is an anal stimulation device that allows you to enjoy sustained anal pleasure (and prostate stimulation for the men folk) without the worry of having your toy fall out, or worse, disappear up your chute.

Let’s look at a typical butt plug to get a feel for how it works. Unlike most dildos and other anal toys, a butt plug is shorter and has a unique shape. The insertable part is often a tapered cone shape, designed for easy insertion and that all-filled-up feeling while it’s in place.

The plug tapers more dramatically near the base into a notch. This allows your sphincter muscle to close down on the plug keeping it firmly in place. Finally the wide base keeps it from slipping inside your bum.

Pretty gal-darn clever, huh?

But why would I want a plug in my ass? You might query. That, my friend, is a question only a rank amateur would ask. Unfamiliar with the joys of butt play, are ya? Well, here’s the 411 on anal pleasuring. Your bum is chock full of nerve ending that, when stimulated, induce intense pleasure. And a butt plug can be worn for hours at a time for a sustained dose of devilish delight.

Once you decide to give a plug a try, you’ll have loads of options to choose from. There is a slue of different sizes, shapes colors and textures. They come in several different materials. And some even vibrate. How fun is that?

Let’s look at all these options in turn.

— Start with SIZE.
If you’re new to the whole anal thing, I recommend you try something small. You’ll want an insertable length of less then 4” and a diameter of 2.5”. Feeling a bit more daring? Want to increase the insertable length and/or diameter? Knock yourself out, my friend. There are dozens of sizes available.

— Next choose a Material.
Got the dimensions you want, but not sure about what kind of material you want plugging your hole? I know that may sound funny, but it actually does matter what you insert where the sun don’t shine!

Say, Dr Dick, how do I know what material is best for me? Excellent question! See, you’re becoming a well-informed consumer already. Let me detail some of the finer points for you.

Latex — the granddaddy of sex toy material.
Soft and flexible
Use with both water-based and oil-based lubes.

Porous, thus less hygienic
Difficult to clean
May contain phthalates
Distinct rubbery odor

Jelly —advancements in chemistry transformed ordinary latex into even softer and more pliable jellies.
Super-soft and flexible
Appealing translucent jelly-like appearance
Use with both water-based and oil-based lubes.
Comes in a variety of colors

Porous, thus less hygienic
Difficult to clean
Probably contain phthalates
Distinct rubbery odor

Silicone — a non-latex product that come in two varieties — firm and soft.
Durable and long lasting
Easy to maintain
You can sterilize silicone toys by boiling themc552.jpg
They’re bleachable
Dishwasher safe
More realistic feel
Retains body heat
Comes in a variety of colors
Less of an odor

More expensive
Use only water-based lubes

Stainless Steel —it is smooth, hard and a thing of beauty.c991.jpg
Super-durable and long lasting
Easy to maintain
You can sterilize Stainless Steel toys by boiling them
Dishwasher safe
Much heftier weight
No unpleasant odor
Can be warmed or chilled
Use with both water-based and oil-based lubes.

More expensive
Hard and inflexible

Pyrex Glass — a hard dense glass that will not shatter or splinter. A work of art.
Super-durable, long lasting
Easy to maintain
You can sterilize Pyrex toys by boiling them
Dishwasher safe
Hefty weight
No unpleasant odor
Can be warmed or chilled
Use with both water-based and oil-based lubes.

More expensive
Hard and inflexible

New Supersoft — a new material that’s has the closest feel to real-life skin. It can be both soft and rigid.
Less expensive
Great texture

Very porous
Less hygienic
Always use with a condom
Use only both water-based lubes.
Difficult to cleanb667.jpg
Distinct rubbery odor

Rubber — An old standard!
Durable, very long lasting
Use with both water-based and oil-based lubes.
Comes in a vast array of colors
Very porous, less hygienic
Difficult to clean
Distinct rubbery odor

— Next choose Special Features.
Once you’ve decided on the material you want, you can customize your butt plug with special features like:

  • Bendable
  • Inflatable
  • Multi speed vibrating
  • Suction cup

— Next choose Texture.
Latex, silicone and rubber butt plugs come in an array of textures. Which one of these buggers will tickles your fancy?

  • Bulgedtunnel plug1
  • Noduled
  • Nubbed
  • Ribbed
  • Smooth
  • Studded
  • Swirled
  • Veined
  • Velvety

Good luck.

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