'Сексуальные проблемы у мужчин'

В норме у молодого здорового мужчины, если он воздер­живается от половой жизни, как правило, при пробуждении от сна отмечается эрекция (напряжение полового члена), сон сопровождается эротическими сновидениями и поллюциями, половое возбуждение может наступить даже при разговоре на сексуальные темы, при одном виде молодых, интересных женщин.Расстройства половой функции чаше всего проявляются в форме половой слабости (импотенции). В большинстве случаев эти расстройства (в форме ослабления эрекции или преждевре­менного семяизвержения), как уже отмечалось, не связаны с какими-то органическими заболеваниями, а обусловлены психо­генными факторами или повышенной половой возбудимостью. Такие расстройства возникают обычно у молодых мужчин, которые впервые в жизни или после долгого перерыва вступают в половые сношения.Повышенная половая возбудимость часто ведет к очень быстрому наступлению эякуляции (преждевременному семяизвер­жению). В некоторых случаях семяизвержение наступает даже до введения полового члена во влагалище.

В норме длительность полового акта весьма варьирует и составляет у мужчин в среднем от одной до пяти минут при непре­рывном интенсивном его проведении.

Быстрое наступление эякуляции не всегда следует рассматри­вать как расстройство половой функции. У здоровых молодых людей, длительно воздерживающихся от половой жизни, эякуля­ция может наступить через несколько секунд от начала полового акта. И это будет нормальное, физиологическое явление. При повторных сношениях половой акт удлиняется.

Об этом молодые мужчины должны знать и помнить, чтобы не опасаться этих явлений и не считать себя неполноценными в половом отношении. К сожалению, многие мужчины в этих вопросах плохо ориентированы, а некоторые из них после первой же неудачи начинают «лечиться» сами. Чтобы «войти в форму», они делают большой перерыв в половых сношениях, принимают возбуждающие средства, а получается все наоборот. Воздержание ведет к усилению полового возбуждения и более быстрой разрядке при попытке вновь начать половую жизнь. Положение усу­губляется, переживания нарастают, появляется и ослабление эрекции полового члена. В результате такого самостоятельного «лечения» страх перед половым сношением нарастает, развива­ется невроз, создается конфликт в семье. О преждевременной эякуляции можно говорить в тех случаях, когда у мужчин она наступает очень быстро, через несколько секунд от начала близости и остается такой длительное время, несмотря на то что половая жизнь протекает систематически. Эти расстройства, связанные с повышенной половой возбуди­мостью, обычно успешно поддаются лечению. Иногда даже не требуется никакого лечения в прямом смысле этого слова, нужен просто совет врача, разъяснение физиологии половой функции, после чего сексуальная жизнь нормализуется.

Помимо повышенной половой возбудимости, причинами преждевременного семяизвержения могут быть такие психические факторы, как боязнь неудачи при половом сношении, страх заражения венерической болезнью, оплодотворение, угрызение совести, чувство отвращения. В одних случаях эти причины ведут к торможению эрекции, в других — к преждевременной эякуля­ции. Постоянное наличие преждевременного семяизвержения обыч­но тяжело переживается, так как оно ведет к дисгармонии половой жизни. Путем отвлечения внимания посторонними мыслями, представлениями, временной приостановкой фрикций при прибли­жении эякуляции некоторые мужчины могут задерживать наступ­ление эякуляции в целях создания гармонии в сексуальной жизни. Однако слишком длительное затягивание полового акта (15—20 мин и дольше) нежелательно, так как может привести к застойным явлениям в половых органах.

Для продления полового акта в некоторых случаях целесо­образно применение по назначению врача препаратов, понижаю­щих возбудимость центра семяизвержения. В отдельных случаях с этой целью можно применять смазывание головки полового члена кокаиновой или анестезиновой мазью за 2—3 ч до полового акта. Чувствительность головки полового члена от применения этой мази уменьшается, вследствие чего половой акт продлевается. С этой же целью применяют кондом. При лечении преждевремен­ной эякуляции используют в ряде Случаев и специальные психоте­рапевтические приемы. Иногда преждевременное семяизвержение может быть обусловлено органическими заболеваниями нервной системы и половых органов. При длительных расстройствах полового акта требуется обследование у психоневролога и уролога.

У мужчин встречается, хотя и редко, половое расстройство в форме асперматизма (не наступление эякуляции), как бы долго ни длилось половое сношение.

Причины асперматизма бывают разные. Различают посто­янный и временный асперматизм. У некоторых больных эякуляция отсутствует при совершении полового акта только с одной определенной женщиной (кортикальный асперматизм), в то время как при сношении с другой женщиной наступает эякуляция с оргазмом. Лечение асперматизма должно быть направлено на устранение основной причины заболевания.

Из психогенных факторов, вызывающих расстройство поло­вой функции, ведущая роль принадлежит различным стра­хам — страху заражения венерической болезнью, оплодотворения женщины, нервозная обстановка, тревожное ожидание неудачи и другие обстоятельства. Чаще всего это встречается у мнительных по характеру людей. У таких лиц страх может, независимо от их воли, оказывать торможение половой функции и тогда эрекция не наступает.

Low G.I. eating means making a move back to the high carbohydrate foods which are staples in many parts of the world. The emphasis is on whole foods like whole grains—barley, oats, dried peas and beans, in combination with certain types of rice, breads, pasta, vegetables and fruits. You’ll find the recipes listed under each of our three main eating occasions—breakfasts, light meals (like soups, salads and pastas), and main meals with additional sections on desserts and snacks. While some of the recipes are specifically modified to lower the G.I. others are included to present new ways of preparing low G.I. foods.

The recipes have been developed to help you reduce the overall G.L factor of your diet improving its nutritional quality while you do it. They are designed to be incorporated into your usual diet, helping you to get your carbohydrate intake up to 50 to 60 per cent of your kilojoule intake and keeping your fat intake down to the recommended level of 30 per cent of kilojoules per day. Protein should stay constant at 10 to 15 per cent of energy. Most of the recipes are high in fibre, both soluble and insoluble.

Each recipe has been analysed for its nutritional value which is given per serve where the recipe is divided into a specified number of serves. The following information will help put this nutritional profile into context for you.

Kilojoules. The metric equivalent of Calories. This is the measure of how much energy the food provides. Those who bum lots of energy through exercise need a higher kilojoule intake than those who live more sedentary lives. A moderately active woman aged 18 to 54 years would consume about 8000 kilojoules a day; a man about 10 000 kilo-joules.

Fat. Our fat requirement is probably as small as 10 grams a day to provide essential fatty acids needed for health. The range of acceptable fat intake depends on your total kilojoule intake. People trying to lose weight could aim for around 30 to 40 grams of fat a day. Most others could do with 50 to 60 grams. Children and adolescents need more than adults because they are growing and should not have their fat intake overt/ restricted.

Carbohydrate. The total amount of carbohydrate (which includes starches and sugars) is listed with each recipe. Our aim is to help you increase your carbohydrate intake as your fat intake drops. It is not necessary to calculate how many grams of carbohydrate you eat on a daily basis, however the athlete or person with diabetes may find this information useful. This is so they can eat enough! On average, women should take in 250 grams of carbohydrate each day while men need about 350 grams. Athletes can consume anywhere from 350 to 700 grams of carbohydrate a day.

Fibre. It is recommended that we consume at least 30 grams of dietary fibre every day. A slice of wholemeal bread provides 2 grams of fibre, an average apple 4 grams. The average Australian consumes only 18 grams of fibre a day.

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Fibre

Food fibre is found in fruits, cereals, beans and vegetables. There are several kinds of fibre and they are not digested in the stomach or bowel, but assist in normal bowel function. They appear to be beneficial in the prevention of certain bowel diseases and particularly help prevent constipation.

There is some evidence that fibre in fruits and cereals and vegetables may help prevent too rapid an absorption of glucose from the carbohydrate in these foods. This is certainly helpful in the control of non-insulin-dependent diabetes, and may also be helpful in the diet of young people with diabetes. Recent evidence shows that a diet rich in fibre leads to better diabetic control.

Water

Fluids, either as water or in some beverage or food, are of course essential to health. Thirst is a good guide to requirements and you should respect a child’s desire to drink by letting him have water freely. Children sometimes drink large quantities of sweet drinks such as cordials and soft drinks and flavoured milk. They may drink these because of their sweet taste rather than their need to have fluids. For this reason sugar containing drinks are not used as part of the diabetic diet and artificially sweetened drinks may need to be rationed to help educate a child not to rely on sweet drinks.

Many solid foods have quite high water content and supply much of a child’s fluid requirements.

Meals provide constant glucose in the bloodstream

A diabetic diet takes into account the need for providing all these foods in proper amounts for good health. However, as well as providing the overall nutritional needs of the body, the regular taking of food ensures that there is a constant supply of glucose being absorbed into the bloodstream throughout the day. Sugars in food (such as fruit or milk) lead to a quick supply of glucose, whereas starches, being more slowly digested, lead to a steadier absorption over a longer period. With snacks at mid-morning, mid-afternoon and supper-time, the glucose supply is given a ‘boost’ which maintains a satisfactory level until the next main meal.

Meal times must be regular

Clearly, if this relatively constant supply of glucose in the blood is to be maintained, meal times have to be as regular as possible. Being late for a meal may mean that the glucose from the previous meal is disappearing from the blood, and too low a level may result. Being too early may lead to too long a gap to the next meal, with the same result.

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The basis for teenage behaviour lies at least in part in the developmental process of adolescence. As every parent of a teenager knows, adolescence is not just a time of rapid growth and sexual maturation. It is also a period of psychological, emotional and social development. This development is just as important for the teenager as physical growth.

Adolescents have to proceed through a number of emotional developmental changes if they are to become mature adults. In many ways this is similar to the toddler as he passes from baby dependence to the independence of self-feeding, toileting and going off to kindergarten. Adolescents also have to achieve independence from their parents and they can make even more fuss in doing so. Teenagers must also establish their own self-esteem, measuring up with others of their age. They have to work out their own sexual feelings and develop a mature attitude to sex as part of a relationship with someone else. They have to work out where they are going, who they are and what their life career will be. They have to do all these things in a few turbulent teenage years with all the stresses of competitive school life and uncertain employment prospects.

It is no wonder that on top of all this a teenager with diabetes may have little time for sticking to all the rules of diabetic control. No wonder, in sorting out priorities, adolescent development may have a higher rating than exact diet and regular blood tests.

Fortunately for parents, adolescence only lasts a few years, but it is also a rewarding and entertaining time for the family. At this time it is important to set realistic goals for care of the diabetes. Realize that precise compliance probably isn’t possible just yet, but will occur later. Recognize that it is probably more important to be a parent and let your child’s doctor act the part of diabetes watch-dog.

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How does your child feel about his diet?

It may be up to you to find out how your child feels about these sweet foods. If he has been used to a lot of sweets, and if the family has tended to regard sweets as rewards, then an abrupt denial of them all (particularly if the rest of the family goes on eating them) may be very upsetting for your child. He may even interpret the denial as a sort of punishment. ‘I ate too much sugar and so I got diabetes. Now I am being punished by being forbidden them.’ This is of course nonsense, but it is surprising how many children feel this way.

Diet is not a punishment

He may rebel and take sweets and cakes when no one is looking. He may yield to temptation occasionally and have a taste of some forbidden food (like a heavy smoker who is advised to stop smoking). In either case he will probably feel guilty afterwards, and this feeling of guilt will be made worse if you blame him, or reproach him, or worse still, punish him.

All children will break their diet occasionally

Children may not always seem logical. They may not believe you if you say that you are stopping them having cake for their own good (especially if you say this while you yourself are enjoying a luscious piece of iced cake).

Much explanation is necessary, and much understanding. If he does break his diet, and you find out, you may find that the best way to act is to let him realize that you know and disapprove, but avoid punishment or blame.

Your child has to live in a society where sweet carbohydrate foods are in profusion, and no party is a party without the cake. You cannot prevent him seeing other children enjoying these things, and although you will make some changes in your own home, you cannot perhaps deny all the rest of the family everything sweet. You may be able to help your child develop strengths of self-discipline in relation to food and show that you are also capable of some self-discipline yourself. You must help your child to accept, not only that he cannot freely have sweet things, but that other people can have them.

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Early warning signs

At the stage when the level of glucose in the blood is falling rapidly, there will usually be warning signs before the level becomes too low. These include hunger, tremulousness, dizziness, headache, shaking, weakness or other odd feelings the child himself learns to recognize. At this stage the child may become pale and sweaty with a rapid pulse rate.

These warning signs are readily corrected by taking sugar.

There may possibly come a time – perhaps because the / warning signs were not recognized or heeded or because they were only present for a few moments, or in some cases they may not have been present at all – when blood glucose may fall to very low levels. When this occurs, it may mean that there is insufficient glucose for the efficient functioning of the brain, which depends on a constant supply of glucose from the blood.

Later signs

So the brain, deprived of sufficient glucose, may act in an unusual fashion and this leads to unusual behaviour of the child. He may become irritable, or cry easily, lose concentration and seem vague or be unreasonable or bad tempered. He may get a headache, or feel dizzy, ‘funny’ or drowsy. He may become weak in some muscles, or develop trembling of his limbs. He may even lose consciousness and some children may have a convulsion although this is very rare.

A hypo reaction may happen quickly

Usually these things develop quite rapidly and at a time when the child has been otherwise well. A normal or even a high blood glucose level earlier in the day does not rule out the possibility that a hypo may occur later, as the blood glucose level may fall quite rapidly from a high to a low level in a few hours.

When may a hypo reaction occur?

Although one child differs from another in his behaviour during a hypo, he tends to have the same sort of reaction each time he has one. Thus he or his parents quickly come to recognize a hypo when it is developing, and treatment can be given at once before more serious signs develop. Hypos tend to occur when sugar produced from a recent meal is largely used up and at its lowest level; often just before the next meal is due. Other times to be on the lookout for hypo reaction are after strenuous exercise or unusual activity. Each type of insulin has its time of maximum effect and at these times there is the most likelihood of an insulin reaction.

Difficulties in recognizing hypo reaction

There will be times in the early stages of your child’s diabetes, and especially if he is a baby or toddler, when you may be uncertain whether unusual behaviour is due to a reaction or not. As you get more experienced, you will learn to recognize reactions quite easily, but if you are in any doubt it is better to regard the unusual behaviour as a reaction and treat it. Note whether there is an improvement after giving treatment; if so it was probably a hypo reaction and if not probably was not. Very occasionally some children ‘put on’ bad behaviour and complain of headache to get the extra sugar you will use to treat the supposed reaction. If you suspect this, do a blood test. A low test will tend to confirm the probability that it is a hypo reaction.

Some symptoms of a hypo – paleness, sweating, shakiness for example, are the result of the body’s reaction when the glucose level in the blood is rapidly falling. This can occur when the glucose is falling from say 6 to 3 mmol/1, so there is a true hypo, but can also occur if, say, the blood glucose falls from 12 to 8 mmol/1. In this case, the child is heading for a hypo but is not actually hypoglycemic. This may explain why the blood test is not always low when symptoms occur.

It also helps to explain why sometimes a child’s blood glucose level may be found to be low but there are no symptoms. In this case, perhaps the blood glucose has been falling slowly, so the body doesn’t recognize the fall and there is no reaction.

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It is best to use a meter

You can use a meter to measure the blood glucose level. There are a number of different meters for this test and from time to time new meters are introduced or old ones upgraded. It is well worth while looking at each of these and discussing how they work with an expert. Diabetes educators are usually aware of the range of meters available and some specialist pharmacists stock a range and can explain them to you. You can also see the range in diabetes clinics and at Diabetes Australia. All of the meters operate on the same principle: they measure the strength of colour that is developed on the test strip and convert it to a blood glucose value. They have a timing mechanism to make sure that the blood is on the strip for the correct time and that the test is read at the correct time. They tell you the result by a digital readout.

You can estimate the blood glucose value without a meter.

Some test strips (the Boehringer BM Glycemie 20/800, Hypo-guard GA, and the AMES Glucostix) can be used without a meter. You have to time the test yourself accurately with a watch, wiping off the blood exactly on time, and then waiting a further 60 seconds for BM 20/800 or 30 seconds for Glucostix before comparing the colour with blocks printed on the container. This method is convenient to use when you are travelling or camping or if you want to do a check at school or work. It is a useful standby if your meter is being serviced. Some people find it difficult to read the test accurately and it must be done in good light.

Why get a meter if it’s not necessary?

Most people with diabetes and parents of children with diabetes have said they much prefer using a meter. It is more accurate and easier to read, especially at very low and very high ranges. The meter has a timing device and this is valuable as most young people tend to become careless at times and just glance at a watch. Older patients who have trouble with vision, may find strips difficult to read visually, a meter is then very helpful.

The main disadvantage is the price. This may not seem so much if you realize that you should get many years of use and hundreds of tests a year. If you do have difficulty affording a meter, some diabetes clinics can lend you one for a while. Sometimes a service club or other organization will help you purchase one. Some health insurance companies refund part or all of the cost.

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