Гипертиреоз – Hypertheriosis

John, a 45-year-old married man, visited his doctor complaining that his erections were no longer satisfactory He couldn’t get a «good» erection, he said—one that was sufficiently firm to allow him to have intercourse.

Trying to find out what was causing John’s poor erections, his doctor gave him a penile shot. The injection produced an erection that was adequate for intercourse, and quite normal as far as the physician could tell. John, however, was distinctly unimpressed. «This is as good as I get when I try to have intercourse, and ifs not good enough,» he lamented.

Obviously, something was wrong. John was physically able to have intercourse—but he was very uncomfortable doing so. His insistence on what he unrealistically considered a «perfect» erection, combined with his fear of disappointing his partner, was ruining his sex life. Emotionally unable to examine his attitudes, he had labeled his penis and his erections as the problem. In John’s view, it was not that he did not want to have intercourse; no, it was just that his penis was not cooperating.

The physician suggested that sex therapy could improve John and his wife’s sexual relationship. It could also help John achieve his goal of more frequent and satisfactory intercourse. But John was clearly unimpressed with the suggestion. «I know I’m not crazy,» he declared, «I don’t want to see any therapist, and I sure don’t need a psychiatrist.» That’s too bad, because the therapy might have solved his problem. And it might have shattered a few myths he has about sex therapy.

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Think of the arteries which carry blood into the penis as expressways. Two of these arteries are the most crucial to erection—they supply the corpora cavernosa, which must fill up with blood in order for a man to become erect. A traffic jam in this finely tuned system—even a minor one—can prevent a man from getting an erection, or make it impossible to maintain one.

Unfortunately, nature did not design a man’s body to give a clear signal—like a rash or a high fever—when such a tie-up occurs. The signs are much more subtle, and sometimes quite difficult to decipher. One way to know if there’s a blockage in the arteries supplying the penis is to check the blood pressure in the penis. Low penile blood pressure means the arteries aren’t doing their job.

Taking the blood pressure in your penis is a painless test, much like the one done to measure pressure in your arm. The equipment used is different, however. The cuff wrapped around the penis is smaller and a special stethoscope is used to allow the doctor to hear the pulse in the very tiny blood vessels in the penis. Usually the doctor will listen to your penile arteries in different places to get an accurate reading.

Your top number penile blood pressure should be at least 70 percent of the top number of your normal, measured-in-the-arm blood pressure. Let’s suppose your regular blood pressure is a normal 120/80. Your penile blood pressure should be at least 70 percent of 120, or 84.

If your pressure is lower than this measurement, it means that not enough blood can get into the penis to produce a good erection. Higher than 70 percent is a good sign that your arterial expressways may be carrying the right amount of traffic.

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Some men aren’t aware that they suffer from stress and performance anxiety. Jimmy, a 24-year-old graduate student at a large university, visited a urologist, complaining that he was unable to get an erection. Like many students, Jimmy was juggling a lot of demands. He had a part-time job, a heavy class load and still made time for personal relationships. He was attractive and charming, so he had little trouble meeting women. The problem, he said, was that his relationships did not last. Occasionally, in a new relationship, Jimmy would become erect, but he usually lost potency before he could have intercourse.

A crucial piece of information came to light when Jimmy revealed that he could get satisfactory erections when he masturbated. He had no trouble sustaining an erection when he was alone. And he frequently awoke with an erection. He had no chronic illnesses, and a complete physical examination showed only that he was a very healthy man.

Jimmy wanted to believe that he had some physical problem to blame for his impotence—something that could quickly and easily be «fixed.» But in his case, anxiety was the culprit. He needed to learn to relax, to give himself permission not to have intercourse until he was ready, to feel comfortable with his partner and not withdraw from her emotionally in the event of a «failure.» Perhaps most of all, he needed to stop looking at intercourse as a test witch he would either pass or fail. To do this he had to learn to be comfortable – physically and emotionally – when close a women.

Jimmy found a sex therapist to help him. You might find that on your own you’re able to pinpoint the factors that make you stressed and overcome them.

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Priapism is when a man gets an erection that won’t go away. While this may sound like everyone’s fantasy, priapism is actually dangerous and serious. Not only is it usually extremely painful, but priapism, left untreated, can cause permanent impotence.

What causes an erection that won’t disappear? There are many known causes of priapism and then there are also some cases which defy explanation. The culprits are the blood vessels not doing their job properly. Rather than draining blood out of the penis on cue, the veins remain shut down and the arteries continue trying to pump blood into the penis. This state of affairs can be caused by sickle cell anemia, trauma to the penis, tumors in the penis or pelvic area or even, in some cases, by blood-thinning medications taken by men to keep their blood from clotting too readily. Some other drugs, such as certain tranquilizers and antidepressants, can also bring on priapism, probably because they affect the nervous system’s control of the blood vessels.

If you find yourself with an erection that will not disappear, go to the nearest emergency room. Priapism needs to be treated within four to six hours after it develops—sooner, if at all possible.

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Performance anxiety can take many different forms. For some men, it is linked to the degree of intimacy in a relationship. One man, 33 years old, could only get an erection in an impersonal setting. He would visit topless bars where, for a fee, a dancer would rub up against him. He could have a full, firm erection this way and ejaculate. But when he liked a woman and developed a friendship with her, he was unable to get an erection.

Sometimes the reverse is true and performance anxiety is only a problem when a man tries to have sex with someone who is a virtual stranger to him. Hal, for example, dated several different women in a short period of time, but he was unable to get an erection with any of them. The common thread in each of these situations was that he didn’t know the woman very well, and he really didn’t feel comfortable with her. Hal’s performance anxiety had to do with wanting to feel secure and accepted as a person, not just as an instrument of sexual satisfaction. Once Hal developed a serious relationship, erections were not a problem. In this case his penis was mirroring his emotional state.

Sometimes performance anxiety is based on beliefs that prove almost intractable to change. Lee, for example, a 26-year-old, developed an infection in the urinary tract which resulted in a painful drip from his penis. Very concerned and in some pain, he came to a hospital clinic for help. A physician properly prescribed some tetracycline, an antibiotic commonly used to clear up the problem. But a so-called friend of Lee’s told him that if he took the medicine, he’d never get an erection again.

After some anxious rumination, Lee decided to take the pills anyway, to rid himself of the painful infection. The medicine cleared up his problem in a week, and Lee should have been back to normal.

But the next time he tried to make love with his girlfriend he was unable to get an erection. This had never happened to him before. And he was not even able to get an erection when he masturbated. These developments threw him into an emotional tailspin, which only worsened when his girlfriend decided to leave him, saying he was no longer «a real man,» Lee was frantic.

About four weeks later, this terrified young man again showed up at the clinic, seeking help. He had not had an erection since he took the medicine, and was absolutely frantic with anxiety. The doctor reassured him correctly that there was no way the antibiotic could have caused his impotence, and suggested that the worry, not the medicine, was at the root of his problem.

Unfortunately, such advice had no effect on Lee’s lack of erection. In his heart, he believed that his «friend» had spoken the truth. He felt doomed to impotence. Hoping to counteract his beliefs, the physician gave him a placebo shot, promising that this «medicine» would clear up any problem Lee had with erections. Alas, the «cure» did not work. Though there was no physical reason for his sudden inability to get an erection, Lee remained impotent. His beliefs were powerful enough to override his sexual desires and his body’s ability to respond.

Lee was referred to a community mental health center for help in overcoming his fears. Although Lee’s case is somewhat extreme, this story is a perfect example of performance anxiety and the enormous power of the mind.

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Pubic pediculosis is due to infestation with the crab louse Phthirus pubis. The adult louse is blue-grey or reddish brown depending on how much blood it contains. It measures 1 to 2 mm diameter and is just visible to the naked eye. Eggs (nits) are in chitin sacs firmly attached to the base of single hairs. Although infestation may spread to other hairy parts of the body except the scalp, it usually involves only pubic and perianal hair. Although this is usually a sexually transmitted infestation, it may be acquired from contaminated toilet seats, towels, underclothing or bedding. Ordinary laundering is sufficient to disinfest clothing and bed linen.

Clinical manifestations

Symptoms may. develop after a period ranging from a few days to several weeks. The louse feeds by sucking blood; the bites may cause intense irritation followed by secondary infection or eczematous changes. The patient may present with black specks on underpants. Many patients are asymptomatic.

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Group III — Persistent generalised lymphadenopathy (PGL) Patients with PGL alone are classified as Group III. PGL is defined as palpable lymphadenopathy (>1 cm) at two or more extrainguinal sites, persisting for more than 3 months. The lymph node groups most commonly enlarged are the anterior and posterior cervical and axillary groups.

Group IV — Other HIV disease

This group includes patients with clinical features of HIV infection other than or in addition to PGL. This group includes cases of AIDS as originally defined for surveillance purposes and cases of AIDS related complex.

Group IV patients are assigned to subgroups A to E which are not mutually exclusive. The subgroups are:

Subgroup A — Constitutional disease

AIDS related complex (ARC) or slim disease — defined as an illness of greater than one month duration characterised by one or more of: fever, night sweats, weight loss greater than 10% of baseline body weight, or diarrhoea.

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The causes of biological false positive reagin (non-treponemal) tests are:

Acute (persisting less than 6 months): acute viral febrile illness (e.g. infectious mononucleosis, viral pneumonia, hepatitis); and pregnancy.

Chronic (persisting six months or more): intravenous drug abuse; autoimmune disease — positive serology may predate the disease (e.g. disseminated lupus erythematosis, rheumatoid arthritis, thyroiditis); malaria; and lepromatous leprosy.

The diagnosis of congenital syphilis is mainly dependent on serology.

Negative serology in the presence of Tpallidum infection may occur in: very early infection; and immunodeficiency following HIV infectioa CSF examination includes white cell count, total protein and VDRL or RPR. Raised lymphocyte count, raised total protein and positive reagin test in the CSF is indicative of neurosyphilis. CSF examination is indicated: where there are symptoms or signs of CNS disease in the presence of positive serological tests for syphilis;

before retreating a patient who has had relapse, treatment failure or reinfection after any form of treatment; in any patient who has been treated with non-penicillin regimens; where late or latent syphilis has been discovered and the period of latency cannot be determined or is in excess of 2 years; or before treatment with benzathine penicillin except in early disease.

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Antibiotics effective against gram negative or anaerobic bacilli are used when PID complicates delivery, abortion or gynaecological procedure or if these organisms complicate gonococcal or chlamydial PID. Various combinations of a penicillin, tetracycline, clindamycin, an imidazole (metronidazole, tinidazole or omidazole) or other agents will be used depending upon the circumstances of each particular case.

In an acute case, the failure to respond to antibiotic treatment in 24 to 48 hours may indicate a mistaken diagnosis (appendicitis, ectopic pregnancy), pus in the pouch of Douglas or tubo-ovarian abscess and surgical intervention may be necessary. Salpingectomy or salpingo-oophorectomy is indicated for tubal or tubo-ovarian abscess. Unless the life of the patient is endangered, trial of antibiotic therapy should be considered if the diagnosis is in doubt

Women with PID should be regularly reviewed to detect reinfections or relapses in an attempt to prevent long term sequelae such as tubal damage leading to ectopic pregnancy or infertility, recurrent pelvic pain, menstrual irregularities and depression.

Male partners of women with PID should be examined and treated if indicated as they often have gonococcal or chlamydial urethral infections.

In 1988, NHMRC approved the publication of a working party report on pelvic inflammatory disease.

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Where an STD exists or is suspected, it is likely that the patient will be embarrassed, fearful, or guilt-ridden. Patients may be less than frank about their sexual activities. Some patients concerned that their sexual behaviour or that of a partner has exposed them to risk may be unable to verbalise that concern. The patient may be belligerent and uncooperative. A patient presenting as the contact of a known case may be upset, angry or disbelieving and may direct these feelings at the practitioner.

The history of the patient’s present symptoms, sexual history and past medical history are important.

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