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Time for a Sexual Revolution In Health Care Treatment

Why is care for sexual health issues considered a luxury when it’s a necessary part of population health?

By Zachary Hafner

When Americans seek care for most common health conditions, there is rarely much question about coverage. Every day, consumers—including those on Medicaid and Medicare—seek care for sore joints, depression, and even acne without worrying about whether or not their insurance will cover their doctor visits and medications. For the most part, coverage for sexual health issues is less straightforward—but why? Is it because sexual health issues are not considered legitimate illnesses? Because the costs are significant? Or is it because raising the topic of sexual health can offend certain personal and organizational values? Whatever the reason, it is time for a change.

It’s hard to deny the human and economic burden of sexually transmitted infections (STIs) on this country. The CDC estimates that 110 million Americans are infected with an STI, resulting in direct medical costs of $16 billion annually. The most common and fastest growing STI in this country is human papillomavirus (HPV), and it is estimated that half of sexually active men and women will get HPV at some point in their lives. In 2006, a vaccine for HPV was introduced and now there are several. CDC guidelines recommend administering a multi-dose series, costing about $250–450, to all boys and girls at age 11 or 12. (Some states require the vaccine for school admission.) It was included in mandatory coverage under the ACA. Since the HPV vaccine was first recommended in 2006 there has been a 64% reduction in vaccine-type HPV infections among teen girls in the United States.

It seems clear that this kind of care for sexual health is necessary for public health and is also part of caring for the whole individual, a central tenet of population health. But what about sexual health care that doesn’t involve infectious disease? Is it still a population health issue if there’s no communicable disease involved?

Let’s take erectile dysfunction (ED) for example. It is nearly as common in men over 40 as HPV is in the general population—more than half of men over 40 experience some level of ED, and more than 23 million American men have been prescribed Viagra. With a significant portion of the population suffering from ED, is it important for payers and providers to consider ED treatment to be essential health care and to cover it accordingly? Medications like Viagra and Cialis are an expensive burden at upwards of $50 per pill. Medicare D does not cover any drugs for ED, but some private insurers do when the medications are deemed medically necessary by a doctor. A handful of states require them to do so, but they are typically listed as Tier 3 medications—nonessential and with the highest co-pays.

Almost 7 million American women have used infertility services. Coverage for infertility diagnosis and treatment is not mandated by the ACA, though 15 states require commercial payers to provide various levels of coverage. The cost of infertility treatments is highly variable depending on the methods used but in vitro fertilization treatments, as one measure, average upward of $12,000 per attempt.

Are treatments for ED and infertility elective or necessary? In an age of consumerism and heightened attention to the whole patient across a broader continuum of care, organizations that support the availability of a broad set of sexual health services to a diverse group of consumers will have a big competitive advantage, but they may face challenges balancing the costs. Health care has advanced in both technical and philosophical ways that allow people to manage their diseases, cure their problems, and overcome limitations. It has also shone light on the significant advantages to considering a diagnosis in the context of the whole individual—their social and emotional health as well as coexisting conditions. Studies have shown, for example, that infertility, ED, and STIs all have a significant relationship with depression and anxiety.

It’s time sexual health was folded in to the broader definition of wellness instead of marginalized as a separate issue. For too many Americans, it’s too big an issue not to address.

Complete Article HERE!

What getting intimate at 60 really means

Most people assume getting saucy under the sheets it just for the young, but what about the young at heart?

By Ashley Macleod and Marita McCabe

Sexuality encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction and what we think, feel and believe about them. It has been a research focus for over a hundred years, and highlighted as an important part of the human experience. Since the first studies on human sexuality in the 1940s, research has consistently demonstrated that sexual interest and activity are sustained well into old age. However, only a fraction of the research has explored sexuality in the later years of life.

Most of the early research on sexuality and ageing looked at the sexual behaviours and biology of older adults, generally ignoring the wider concept of sexuality. When researchers did discuss sexuality more broadly, many referred to sexuality as the domain of the young, and emphasised this was a major barrier to the study of sexuality in older adults.

Sexuality in later life ignored

Towards the end of the 20th century, research expanded to include attitudes towards sexual expression in older adults, and the biological aspects of sexuality and ageing. Consistently, the research showed sexual expression is possible for older adults, and sustained sexual activity into old age is more likely for those who had active sex lives earlier in life.

By the late 1980s, there was a strong focus on the biological aspects of ageing. This expanded to include the reasons behind sexual decline. The research found these were highly varied and many older adults remain sexually active well into later life.

But despite evidence adults continue to desire and pursue sexual expression well into later life, both society in general and many health professionals have inadvertently helped perpetuate the myth of the asexual older person. This can happen through an unintentional lack of recognition, or an avoidance of a topic that makes some people uncomfortable.

Why does this matter?

These ageist attitudes can have an impact on older adults not only in their personal lives, but also in relation to their health needs. Examples include the failure of medical personnel to test for sexually transmissible infections in older populations, or the refusal of patients to take prescribed medications because of adverse impacts on erection rigidity. We need more health practitioners to be conscious of and incorporate later life sexuality into the regular health care of older adults. We still have a long way to go.

By ignoring the importance of sexuality for many older adults, we fail to acknowledge the role that sexuality plays in many people’s relationships, health, well-being and quality of life. Failure to address sexual issues with older patients may lead to or exacerbate marital problems and result in the withdrawal of one or both partners from other forms of intimacy. Failure to discuss sexual health needs with patients can also lead to incorrect medical diagnoses, such as the misdiagnosis of dementia in an older patient with HIV.

It’s not about ‘the deed’ itself

In a recent survey examining sexuality in older people, adults aged between 51 and 89 were asked a series of open-ended questions about sexuality, intimacy and desire, and changes to their experiences in mid-life and later life. This information was then used to create a series of statements that participants were asked to group together in ways they felt made sense, and to rank the importance of each statement.

The most important themes that emerged from the research encompassed things such as partner compatibility, intimacy and pleasure, and factors that influence the experience of desire or the way people express themselves sexually. Although people still considered sexual expression and sexual urges to be important, they were not the focus for many people over 45.

Affectionate and intimate behaviours, trust, respect and compatibility were more important aspects of sexuality than intercourse for most people. Overall, the message was one about the quality of the experience and the desire for connection with a partner, and not about the frequency of sexual activities.

People did discuss barriers to sexual expression and intimacy such as illness, mood or lack of opportunity or a suitable partner, but many felt these were not something they focused on in their own lives. This is in line with the data that shows participants place a greater importance on intimacy and affectionate behaviours such as touching, hugging and kissing, rather than intercourse.

These results help us challenge the existing stereotype of the “asexual older person” and the idea intercourse is necessary to be considered sexually active. They also make it clear researchers and health practitioners need to focus on a greater variety of ways we can improve the experience and expressions of sexuality and intimacy for adults from mid-life onwards beyond medical interventions (like Viagra) that focus on prolonging or enhancing intercourse.

Complete Article HERE!

For Veterans, Trauma Of War Can Persist In Struggles With Sexual Intimacy

U.S. Marines march in the annual Veterans Day Parade along Fifth Avenue in 2014 in New York City.

By

Much has been said about the physical and psychological injuries of war, like traumatic brain injury or post-traumatic stress disorder. But what we talk about less is how these conditions affect the sexual relationships of service members after they return from combat.

Since 2000, service members who were deployed received at least 138,000 diagnoses of PTSD. More than 350,000 have been diagnosed with traumatic brain injury since 2000. Evidence suggests the numbers are actually higher because many don’t seek treatment.

These conditions cause their own sexual side effects, such as emotional numbness, loss of libido and erectile dysfunction. And the long list of medications used to treat PTSD, TBI and other medical conditions can worsen those side effects.

‘He would sleep for days’

Chuck and Liz Rotenberry of Baltimore struggled with their own challenges when Chuck returned from Afghanistan in 2011. He’s a former Marine gunnery sergeant who trained military working dogs. He left active duty in 2012.

For Liz and Chuck, sex had never been a problem. They’ve been married for 14 years and they’re still very much in love. Liz says she fell for Chuck in high school. He was that guy who could always make her laugh, who always had a one-liner ready and never seemed sad.

But when Chuck returned from Afghanistan, their relationship would soon face its greatest challenge. Baby No. 4 was just two weeks away; for sure, it was a chaotic time. But Liz noticed pretty quickly, something was terribly wrong with her husband.

“I wouldn’t be able to find him in the house and he wouldn’t be outside, and I’d find him in a separate bedroom just crying,” Liz says. “He would sleep for days. He would have a hoodie on and be just tucked away in the bed, and he wouldn’t be able to get out of bed. He would have migraines that were so debilitating that it kept him in the bed.”

When Chuck was in Afghanistan, an IED — improvised explosive device — exploded 3 feet behind him. Shrapnel lodged into his neck and back.

It would take three years for someone at the Department of Veterans Affairs to explicitly lay out for Liz that Chuck had developed severe post-traumatic stress and suffered a traumatic brain injury — and that she would need to be his caregiver.

The Marine self-image

During that three-year period, there were times Chuck estimates he was taking 15 to 16 different medications twice a day.

Sex was usually the furthest thing from his mind.

“I didn’t think about it. I wanted to be with Liz, I wanted to be near her,” he says. “When the desire was there, it was unique. It was rare, as opposed to the way it was before. And a lot of times, with the mountains of medication I was on, you know, in my head [it was] all systems go, but that message didn’t go anywhere else.”

Liz noticed that Chuck stopped initiating physical affection.

“The thought of him reaching out to me to give me a hug wasn’t existent. It was like I had to give him the hug. I now had to step in and show him love,” she says.

Sometimes months would go by before they would have sex.

“It started off as being pretty embarrassing, pretty emasculating,” Chuck says. “It was like, ‘Really? This too doesn’t work?’ You blame it on, ‘Oh, it’s just the medication,’ or ‘You’re tired,’ or whatever initially, and you don’t realize it’s stress or my brain just doesn’t work like it used to.”

Liz and Chuck had never really talked about sex in any serious way before. So they kept avoiding the conversation — until this year. That’s when Chuck finally asked his primary care provider for help. The doctor prescribed four doses of Viagra a month. Liz and Chuck say the medication has improved things substantially — though they joke about how few doses the VA allots them every month.

But asking for just those four doses took Chuck three or four visits to the doctor before he could work up the nerve. He says it can be especially hard for a Marine to admit he’s having problems with sex because it contradicts a self-image so many Marines have.

“You know, as a Marine, you can do anything. You believe you can do anything, you’ve been trained to do nearly anything,” he says. “You’re physically fit. You’re mentally sound. Those are just the basics about being a Marine.”

If he has any advice for a Marine going through the same thing he and his wife are facing, he says you need to talk about it. Bring it up with your spouse. Bring it up with your doctors.

“Marines always jokingly hand out straws. You got to suck it up. You got to do what you need to do to get it done,” Chuck says. “It’s just a different mission. … Don’t let your pride ruin what you worked so hard for.”

 Complete Article HERE!

Research finds that older people’s sexual problems are being dismissed

Older people’s sexual activity problems and desires are being dismissed by health practitioners due to their age, a new study has suggested.

seniors

Research by The University of Manchester’s MICRA (Manchester Institute for Collaborative Research on Ageing) and Manchester Metropolitan University highlighted the obstacles some older couples face in maintaining fulfilling sexual lives, and how they adapt to these barriers.

The study analysed written comments from over a thousand adults aged 50 to 90 who responded to the English Longitudinal Study of Ageing Sexual Health and Relationships questionnaire. Respondents of both sexes emphasised their anxiety at not being taken seriously by health practitioners as they sought to overcome issues affecting their , such as a drop in sexual desire or physical difficulties. One man in his eighties reported being refused Viagra for erectile dysfunction on the grounds of cost.

Participants in the study, published in Ageing and Society, cited other elements influencing sexual activity, including health conditions and physical impairment, the evolving status of sex in relationships and mental wellbeing. It was also found that men were more likely to talk about the impact of on sexual activities, but women were more likely to talk about health-related sexual difficulties in the context of a relationship.

The study recommends that health care practice should positively engage with issues of sexual function and sexual activity to improve the health and wellbeing of , particularly in the context of long-term health problems.

“This research further improves our understanding of love and intimacy in later life”, said study co-author David Lee, Research Fellow from The University of Manchester. “It builds upon empirical findings published in our earlier paper (Sexual health and wellbeing among older men and women in England; Archives of Sexual Behaviour) which described a detailed picture of the sex lives of older men and women. However, this new research uses narrative data to better understand how changing age, health and relationships interrelate to impact sexual health and satisfaction.”

“Appreciating individual and personal perspectives around sexuality and sexual is of paramount importance if we are to improve services for older people.”

Complete Article HERE!

Hard times – the ups and downs of the penis

Penises can be problematic. They are powerful, untameable beasts, capable of wielding immense pleasure but also able to cause devastating emotional wounds. And that’s just anal sex

fun, fun, fun

by Liam Murphy

As well as the obvious physical harm that can be inflicted – skinny jeans have cursed a generation to suffer cock-caught-in-fly related trauma – the magnificent meat mallet can also bring mental torment when, like an untrained puppy, it just won’t do as it’s told.

THE HARDER THE BETTER?
Some of the best things are hard: hard-boiled eggs, biscuits, those rhubarb and custard sweets, Tom Hardy and, of course, the penis. However, sometimes they can spring up at the most unexpected and inopportune times, and just won’t go away.

“I call my hard-on issue uncontrollable as such,” says 21-year-old Ian, “let’s say ‘eager’ or ‘keen’. It doesn’t take much and it’s ‘up periscope’ time. I’ve been this way as long as I’ve appreciated the male form. I went through a phase of wearing an over the shoulder bag in my late teens so I could cover the odd bus boner (the vibrations cause a right disturbance). Rather that than poke someone in the eye on the way past, I guess!”

However, impromptu erections can also lead to embarrassing retail situations, as Ian explains. “Recent men’s fashion means that I’ve become accustomed to skinny fit jeans, and for whatever reason, I went commando that day – I’m sure you know where I’m going with this – and I guess it must have been particularly sensitive or whatever. Anyway, I ended up with a lob-on in Tesco. My skinny jeans/tight t-shirt combo meant there was no hiding, so I did what any self-respecting bloke would do. I awkwardly leant over the shopping trolley for the next ten minutes. On the upside, I can also get hard on demand! It’s just a combination of a high sex drive and an involuntary physical reaction, I think.”

For Kieran, 25, his perilously perky penis is just part of his day. “I wouldn’t say it’s an issue – more just a fact of life. Some people sweat a lot, some people yawn a lot… I get boners a lot. Not getting them would be an issue, but getting too many, yeah that’s a ‘problem’ I’m OK with – at least I know it’s all working well. It does pop up at any time. When I was due to be giving a talk, someone gave me a wink and boom… up popped my friend downstairs to take his moment centre stage. I stood behind the lectern desperately thinking of Margaret Thatcher and trying to kill it so I could step out and begin my talk properly. The worst though, is when someone you don’t fancy or don’t want to have sex with tries it on and it just feels like he’s betraying you.”

And how does one manage the curse (or blessing, depending on your perspective) of a perpetual hard-on? “Like everyone else I learned the ‘tuck it behind your belt’ trick, or to hide it behind my belt. Granted, occasionally there have been times when I’ve had to miss my tube stop and stay sitting down while I waited for one to subside.”

Will, 38, didn’t notice the problem cropping up until he was in a relationship. “I was never aware of it until I met my boyfriend and it became apparent early on that I would get erect whenever I was around him. It has settled down a bit now but whenever we kissed in public I would get a twinge. And in bed it still sometimes feels like I have an erection all night. I would generally be embarrassed that I was getting these erections. I felt immature. This is what happens to a teenager, not an adult. I was going through a difficult break-up once – lots of tears – we were cuddling and I was hard. I realised then that my hard-ons were not always about sex – to me they were about love too.”

PENIS PROBLEMS
Erectile dysfunction can happen to a lot of people, in varying degrees and for many reasons, medical or otherwise.

“It happens to me every time I put on a condom,” admits Steven, 34. “I have no problem keeping it up before fucking – wanking and getting sucked off have never been a problem – but when I go to fuck someone and I slide the condom on, I lose the hardness. Not totally, but enough that I can’t properly put it in someone’s arse and enough that the sensation goes for me.”

Steven tried mixing up condom brands. “I’ve used thin, ultra-thin, ribbed, tingle… every version of a condom you could imagine and I still get the same flaccid result. I think it must be a psychological thing, because it’s not like I can’t get hard at all. It’s fine when I bareback with long term boyfriends, but with one nighters I tend to have to bottom now.”

Anxiety can often be a cause of not being able to maintain an erection, as 27-year-old James confirms: “Sex in general makes me anxious. I hate getting naked and I get so nervous when it comes to getting down to it in bed. I was dating a guy I really liked, so much that when he touched me I would physically shake, but when it came to sex I just couldn’t get hard. He thought I didn’t like him! And now I dread having sex. I love the dating side of it but I always know that heading to the bedroom is going to be inevitable.”

dick-words

What can cause you to have trouble getting or staying hard?

  • Stress and anxiety.
  • Depression.
  • Hormone levels.
  • Smoking, recreational drugs and alcohol.
  • Some prescribed drugs – like Prozac and Seroxat.
  • Diabetes, high cholesterol and high blood pressure.
  • Psychological reasons – the more you worry about your erection, the less likely you are to be able to get one.

What can I do to make myself hard?
If you think the reason is psychological – a distraction helps, so encourage your partner to focus on something other than your cock for a while – kissing or nipple play might help to get you back in action.

  • Cockrings can also be used to help maintain a hard-on – leather or rubber straps are safer to use.
  • Counselling.
  • Drugs like Viagra or Cialis – consult your doctor for these.

Matthew Hodson, CEO of GMFA told us: “Rolling a condom onto a rock-hard penis isn’t a problem but if it’s a bit soft and you start to get anxious then it’s easy to spiral with anxiety to the point where a condom is really tricky to use. The more you’re concerned that you won’t be hard enough to use a condom, the more likely it is to happen. If it’s just an occasional problem it’s probably best not to make a big thing of it and just do something else that turns you on while you wait for it to get hard again. If it’s becoming more of a problem, you might want to experiment with cock-rings or talk with your GP about it – there’s no need to be embarrassed, you won’t be the first person who will have approached them with the same problem. Most erection problems can be addressed so there’s no reason why a temporarily soft dick should be a long-term barrier to you enjoying sex safely.”

Everyone should be able to enjoy a penis (which is my campaign slogan if I ever run for Prime Minister), especially their own. Whether it’s too hard or too soft, it doesn’t mean you and your cock have to suffer alone. Confide in your partner/lover/friend/doctor and discuss what you can do to get you and your lifelong pleasure companion talking again.

Step 1: When your cock is hard, take the condom out of the wrapper carefully using your fingers. Using your teeth to tear the packet could damage the condom. Squeeze the air out of the teat on the tip of the condom (if there is one) and put it over the end of your cock. Don’t stretch it and then pull it over your cock as this will make it more likely to break.

Step 2: Roll it down the length of your cock – the further down it goes the less likely it is to slip off. Put some water-based or silicone-based lubricant over your condom-covered cock. Put plenty of lube around his arse too. Don’t put any lube on your cock before you put the condom on, as this can make it slip off.

Step 3: Check the condom occasionally while fucking to ensure it hasn’t come off or split. If you fuck for a long time you will need to keep adding more lube. When you pull out, hold on to the condom and your cock at the base, so that you don’t leave it behind. Pull out before your cock goes soft.

What lube should I use?

When you don’t use enough lube, or use the wrong kind, the likelihood of condom failure is increased, making transmission of HIV and other STIs possible. Water-based lubes (e.g. K-Y, Wet Stuff and ID Glide) and silicone-based lubes (Eros Bodyglide and Liquid Silk) work well with condoms. Oil-based lubricants like cooking oil, moisturisers, sun lotions, baby oil, butter, Crisco, Elbow Grease, etc. can also cause latex condoms to break.

They can however be used with non-latex condoms, like Durex Avanti, Mates Skyn or Pasante Unique. Don’t use spit as it dries up quickly and increases the chance of your condom tearing.

Complete Article HERE!