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By V. Julio. Central Pennsylvania College.

Gartner noted that many sexually abused men order on line cialis erectile dysfunction normal age, left untreated generic cialis 20 mg with mastercard erectile dysfunction doctor memphis, develop depression order discount cialis on-line erectile dysfunction drug coupons, flashbacks, and compulsive behavior (for instance, becoming a sexually compulsive) to cope with being traumatized by the sexual abuse experience. Others spoke about how being betrayed in an important relationship has now affected their ability to have intimate relationships. Other topics included: being too ashamed to talk to anyone about what happened, the cycle of victimization, the fear of becoming an abuser (do boys who were abused become men who are abusive? So we all start off on the same page, can you please define " sexual abuse " for us? It seems it has a lot to do with the way they perceive themselves as men, or being afraid of how others will perceive their manhood. David: And so is there a different way that men perceive their abuse vs. Gartner: Well, often men see early, premature sexual behavior as a sexual initiation. Often they convince themselves that they initiated the sexual situation with the adult. This is one way of feeling that they were in charge in an exploitative situation. David: Does sexual abuse affect men differently than women? There are many aftereffects that both men and women often show, like flashbacks, depression, or compulsive behavior of one sort or another. Men, however, have been socialized to believe that men do not have "weak" feelings so they do not let themselves be vulnerable if they can help it. Often to avoid the sense of being powerless, they become what we call hyper-masculine, behaving in stereotypically masculine ways, but these hyper-masculine behaviors make it very difficult to process what was a very painful exploitation. And is that a result of the compensatory behavior -- acting more like a "man"? Men are likely to say that they were not traumatized by the abusive behavior, especially young men in their late teens to mid-20s. However, men with histories of unwanted childhood sexual behavior with adults are much more likely to come to psychotherapy than men without those histories, but for reasons that SEEM unrelated to the abuse. If a child is betrayed in an important relationship, especially with a loved and trusted caretaker, as is often the case, then the trauma is not just about the sexual acts but about the break in the trusting relationship. This makes it harder to enter trusting intimate relationships later in life. A man may have some kind of sexual dysfunction which, of course, affects his intimate relationships. He may be sexually compulsive, or feel numb during sex, especially if he feels, even for a moment, that he is not in charge of what is happening, so he may not allow himself to truly BE intimate with another person. David: Now, this may sound silly, but a lot of sexually abused men are concerned about this. Will male childhood sexual abuse affect your sexuality? It is an important question; it relates to a fear that makes many boys and men not talk about their abuse. Conventional wisdom is that early sexual contact with a man can "turn" a boy gay, but most clinicians believe that sexual orientation is well formed by the age of 5 or 6 and for boys, the average age of their first abuse is about 9. In addition, gay men with sexual abuse histories report that they usually had a sense that they were gay BEFORE the abuse occurred. The problem is that boys growing up to be gay, in almost all cases as they try to understand their sexuality, ask themselves "Why am I this way? David: Also, many times when we think of abuse, for whatever reasons, we think of men as the perpetrators of the abuse. Gartner: There are far more female abusers than most people believe. In a study at the University of Massachusetts at Boston they found that, of the men who acknowledged a history of abuse, about 40% said they had had a female abuser (this includes men who were abused by both men and women). Gartner: This does indeed sometimes happen, unfortunately. I have known of cases where both parents included the boy in some sexual act together. Is there a particular question about such a situation that you want to ask? David: I would imagine, especially after an experience like that, it would be hard to trust anyone again? Gartner: That is true -- yet many men have enormous resources within and can overcome even such a total betrayal. Have you known anyone to overcome this fear of giving and receiving love due to sexual abuse? Gartner: Yes, definitely -- it requires a lot of patience and often a relationship with a therapist is helpful here. Having someone to talk to about the distrust, and someone to, perhaps, learn to trust. Of course, some partners are also very patient and can be very helpful if they do not take the reluctance to show love as a personal attack. There are, for example, a number of books that can be helpful here -- a small number, but it is growing. Victims No Longer by Mike Lew, Abused Boys by Mic Hunter, and my own Betrayed as Boys (which is written for professionals but I believe is accessible to many men). So I would hope that men would reconsider their concerns about being in therapy. Are you not brought up to respect and honor your mother and father? Gartner: That is exactly right -- that is why the betrayal is so huge. If a boy is lucky, there is someone in his life to whom he can turn -- a teacher, or grandparent, for example. It is very difficult to allow yourself to let in what was done to you, if it was done by a parent. Especially because, in some cases, that parent is beloved and helpful and supportive in some ways. Gartner: An adult does have more resources to figure it out, but it is indeed very difficult. Often good hospitals have rape intervention programs, and while these were developed to help women who were raped as adults or who have a history of child abuse, the good ones know to treat men as well, and often that help is free. At least they should be able to refer you to an appropriate place. There are also centers that treat abuse and incest in some cities. I have known boys who made it their business as they got older to find people in whom they could confide. If a boy or man feels too ashamed to talk to anyone about what happened, then it festers.

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Patients should be advised to contact the prescribing physician if other anti-hypertensive drugs or new medications that may interact with LEVITRA are prescribed by another healthcare provider discount cialis master card erectile dysfunction viagra cialis levitra. Physicians should advise patients to stop use of all PDE5 inhibitors discount cialis online mastercard thyroid erectile dysfunction treatment, including LEVITRA purchase cialis 20mg amex impotence occurs when, and seek medical attention in the event of sudden loss of vision in one or both eyes. Such an event may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision, including permanent loss of vision, that has been reported rarely post-marketing in temporal association with the use of all PDE5 inhibitors. It is not possible to determine whether these events were related directly to the use of PDE5 inhibitors or to other factors. Physicians should also discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators such as PDE5 inhibitors (see POST-MARKETING EXPERIENCE/Ophthalmologic). Physicians should discuss with patients the potential cardiac risk of sexual activity for patients with preexisting cardiovascular risk factors. The use of LEVITRA offers no protection against sexually transmitted diseases. Counseling of patients about protective measures necessary to guard against sexually transmitted diseases, including the Human Immunodeficiency Virus (HIV), should be considered. Physicians should inform patients that there have been rare reports of prolonged erections greater than 4 hours and priapism (painful erections greater than 6 hours in duration) for LEVITRA and this class of compounds. In the event that an erection persists longer than 4 hours, the patient should seek immediate medical assistance. If priapism is not treated immediately, penile tissue damage and permanent loss of potency may result. Effect of other drugs on LEVITRAIn vitro studies: Studies in human liver microsomes showed that vardenafil is metabolized primarily by cytochrome P450 (CYP) isoforms 3A4/5, and to a lesser degree by CYP 2C9. Therefore, inhibitors of these enzymes are expected to reduce vardenafil clearance (see WARNINGS and DOSAGE AND ADMINISTRATION ). In vivo studies: Cytochrome P450 InhibitorsCimetidine (400 mg b. It is recommended not to exceed a single 5 mg dose of LEVITRA in a 24-hour period when used in combination with erythromycin. Ketoconazole (200 mg once daily) produced a 10-fold increase in vardenafil AUC and a 4-fold increase in Cmax when co-administered with LEVITRA (5 mg) in healthy volunteers. A 5-mg LEVITRA dose should not be exceeded when used in combination with 200 mg once daily ketoconazole. Since higher doses of ketoconazole (400 mg daily) may result in higher increases in Cmax and AUC, a single 2. The interaction is a consequence of blocking hepatic metabolism of vardenafil by ritonavir, a highly potent CYP3A4 inhibitor, which also inhibits CYP2C9. Ritonavir significantly prolonged the half-life of vardenafil to 26 hours. Consequently, it is recommended not to exceed a single 2. Other Drug Interactions: No pharmacokinetic interactions were observed between vardenafil and the following drugs: glyburide, warfarin, digoxin, Maalox, and ranitidine. In the warfarin study, vardenafil had no effect on the prothrombin time or other pharmacodynamic parameters. Effects of LEVITRA on other drugsVardenafil and its metabolites had no effect on CYP1A2, 2A6, and 2E1 (Ki > 100~lM). Weak inhibitory effects toward other isoforms (CYP2C8, 2C9, 2C19, 2D6, 3A4) were found, but Ki values were in excess of plasma concentrations achieved following dosing. The most potent inhibitory activity was observed for vardenafil metabolite M1, which had a Ki of 1. Nitrates: The blood pressure lowering effects of sublingual nitrates (0. These effects were not observed when LEVITRA 20 mg was taken 24 hours before the NTG. Potentiation of the hypotensive effects of nitrates for patients with ischemic heart disease has not been evaluated, and concomitant use of LEVITRA and nitrates is contraindicated (see CLINICAL PHARMACOLOGY, Pharmacodynamics, Effects on Blood Pressure and Heart Rate When LEVITRA is Combined with Nitrates; CONTRAINDICATIONS ). Nifedipine: Vardenafil 20 mg, when co-administered with slow-release nifedipine 30 mg or 60 mg once daily, did not affect the relative bioavailability (AUC) or maximum concentration (Cmax) of nifedipine, a drug that is metabolized via CYP3A4. Nifedipine did not alter the plasma levels of LEVITRA when taken in combination. In these patients whose hypertension was controlled with nifedipine, LEVITRA 20 mg produced mean additional supine systolic/diastolic blood pressure reductions of 6/5 mm Hg compared to placebo. Blood pressure effects in patients on stable alpha-blocker treatment: Two clinical pharmacology studies were conducted in patients with benign prostatic hyperplasia (BPH) on stable-dose alpha-blocker treatment for at least four weeks. Study 1: This study was designed to evaluate the effect of 5 mg vardenafil compared to placebo when administered to BPH patients on chronic alpha-blocker therapy in two separate cohorts: tamsulosin 0. The design was a randomized, double blind, cross-over study with four treatments: vardenafil 5 mg or placebo administered simultaneously with the alpha-blocker and vardenafil 5 mg or placebo administered 6 hours after the alpha-blocker. Blood pressure and pulse were evaluated over the 6-hour interval after vardenafil dosing. One patient after simultaneous treatment with 5 mg vardenafil and 10 mg terazosin exhibited symptomatic hypotension with standing blood pressure of 80/60 mmHg occurring one hour after administration and subsequent mild dizziness and moderate lightheadedness lasting for 6 hours. For vardenafil and placebo, five and two patients, respectively, experienced a decrease in standing systolic blood pressure (SBP) of >30 mmHg following simultaneous administration of terazosin. Hypotension was not observed when vardenafil 5 mg and terazosin were administered 6 hours apart. Following simultaneous administration of vardenafil 5 mg and tamsulosin, two patients had a standing SBP of 30 mmHg. When tamsulosin and vardenafil 5 mg were separated by 6 hours, two patients had a standing SBP 30 mmHg. There were no severe adverse events related to hypotension reported during the study. The design was a randomized, double blind, two-period cross-over study. Vardenafil or placebo was given simultaneously with tamsulosin. Blood pressure and pulse were evaluated over the 6-hour interval after vardenafil dosing. One patient experienced a decrease from baseline in standing SBP of >30 mmHg following vardenafil 10 mg. There were no other instances of outlier blood pressure values (standing SBP 30 mmHg). Three patients reported dizziness following vardenafil 20 mg. In those patients who are stable on alpha-blocker therapy, LEVITRA should be initiated at the lowest recommended starting dose (see DOSAGE and ADMINISTRATION). Blood pressure effects in normotensive men after forced titration with alpha-blockers:Two randomized, double blind, placebo-controlled clinical pharmacology studies with healthy normotensive volunteers (age range, 45-74 years) were performed after forced titration of the alphablocker terazosin to 10 mg daily over 14 days (n=29), and after initiation of tamsulosin 0.

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By grade 10 purchase 10 mg cialis free shipping erectile dysfunction doctor in jacksonville fl, she had already attended 13 different schools 20 mg cialis for sale icd 9 code erectile dysfunction neurogenic. She usually was friends with 1 person and when her family moved discount cialis 2.5 mg otc weak erectile dysfunction treatment, the friendship ended. Trish was diagnosed with Avoidant Personality Disorder (AvPD) about 18 years ago, after her first suicide attempt. Before her diagnosis, her mental illness was ignored by her parents, arguing she was "troublesome". Even when Trish found psychiatric help, it took 10 years for her to find a psychiatrist who totally understood her illness and prescribed the right medication for her. Borderline Personality Disorder (BPD) can be a devastating mental condition, both for the people who have it and for those around them. Fortunately help is available, and people diagnosed with BPD can live happier and healthier lives. Mahari,our guest on HealthyPlace Mental Health TV Show, talks about how to cope with a loved one with Borderline Personality Disorder. We invite you to call our automated number at 1-888-883-8045 and share your experience with coping with a loved one with BPD in your life. Mahari is a 53-year old Canadian woman, author, life coach, mental health coach, blogger, podcaster and radio show host. After her recovery from Borderline Personality Disorder, Mahari set up a website and began writing articles about her experience and her recovery. A few years later she began writing ebooks, doing audios and videos about BPD. Sam Vaknin is a narcissist, author of the best-seller Malignant Self-Love, Narcissism Revisited. Sam was our guest on the HealthyPlace Mental Health TV Show and he talked about abusers, narcissists, and how to deal with them. We invite you to call our toll-free number at 1-888-883-8045 and share your experience with abuse and narcissists. While there, listen to his audio comments on his homepage. You can share your experiences by calling the toll free number under the audio widget. Epilepsy was once thought to be a psychiatric problem, until the underlying neurological abnormalities were understood. Researchers have uncovered medical and neurological abnormalities in borderlines. In my opinion, the borderline personality disorder is primarily a medical problem. Imagine you are faced with a minor stress - a flat tire, a clogged-up sink, or a trivial disagreement with your spouse, friend, lover, child, etc. Instead of finding an acceptable solution, your mind seems to panic. A sense of unease develops, possibly causing discomfort in the stomach or chest. Feelings of anxiety complicate the increasing sense of uneasiness and restlessness. Over the next few minutes to hours, other negative sensations creep in - including memories of past hurts - until you are experiencing virtually every bad emotion a human can feel. Your psychological defenses are overwhelmed by unbearable emotional pain. You find yourself unable to cope as your mind and body are now in a full scale panic. As the pain continues to intensify the nervous system creates bizarre sensations such as emptiness, numbness, and unreality. You become incapable of rational thinking as the panic continues to worsen. Your mind now desperately tries to find a way out of the pain and searches for solutions. It recalls past activities that have made you feel better. Once a method is found, your mind frantically forces you to pursue that activity to a self-destructive excess - finally resulting in a biochemical rescue. But how can you ever feel normal again knowing that such a horrible experience will return? How can you feel normal again when your self-destructive and inappropriate behaviors are witnessed by family, friends, employers and/or co-workers? How can you feel normal again when those behaviors result in financial, interpersonal, physical, or legal trouble? For those not afflicted with the Borderline Disorder this is a nightmare we hope never happens to us. Borderlines experience it over and over - especially when confronted with stress. Borderlines will do almost anything to make dysphoria go away. Most impulsiveness and self-destructiveness is an effort to relieve dysphoria. Some borderlines, especially those suffering very severely, will literally cut their bodies during dysphoria. Borderlines are victims of an incredibly painful illness... The symptoms can be so unpleasant to those interacting with borderlines that feelings of compassion and understanding may be difficult or impossible to feel. Borderlines desperately want to be loved, but their illness makes them at times seem unlovable. They are terrified of being abandoned, yet are powerless to keep the illness from destroying relationships. Genetic factors are important - borderline tends to run in families. The risk of developing borderline is 6 times higher when a close relative has the disorder. In studies of identical twins, researchers have discovered that many personality traits are genetically determined. Borderlines commonly suffer from other disorders as well. PMS, depression, hypothyroidism, vitamin B 12 deficiency, other personality disorders, anxiety, eating disorders, and substance abuse problems are the most common. Intelligence is not affected by the disorder, but the ability to organize and structure time can be severely impaired. While many borderlines suffered from abuse or neglect in childhood, some developed the disorder from head injuries, epilepsy, or brain infections.

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The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder quality 10 mg cialis impotence solutions. Criteria are not met for Conduct Disorder purchase cialis without prescription erectile dysfunction names, and buy generic cialis on-line erectile dysfunction age 16, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder. Several theories about the causes of Oppositional Defiant Disorder are being investigated. Some studies also suggest that having a mother with a depressive disorder can result in a child with ODD. For more on oppositional defiant disorder and extensive information on parenting challenging children, visit the Parenting Community. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Merck Manual, Home Edition for Patients and Caregivers, last revised 2006. Comprehensive information on Panic Disorder, Panic Attacks. Description of panic disorder plus signs, symptoms, causes and treatment of panic disorder. You stand there in the lobby with your heart pounding, barely able to breathe. Other office workers file past you, looking back over their shoulders to see if something is wrong. The crushing fear of the panic attack most often passes after a few minutes, but in its wake it leaves a residue of uneasiness: when might the panic come again? Modern life, with its pace, its pressures to perform and produce, and its difficult relationships, seems at times almost to be a factory for stress. The panic attacks stemming from the illness often strike in familiar places where there is seemingly "nothing to be afraid of. Surroundings can take on an unreal cast, and a combination of symptoms sparks like the current in a crosswired fire alarm: the heart races, breathing gets shallower and faster, the whole nervous system signals: DANGER. The person suffering under this barrage may be convinced he or she is having a heart attack or stroke, or that he or she is going crazy or going to die. Researchers have determined that panic attacks are usually classified as being part of a panic disorder if they occur frequently (one or more times during a given four-week period) and are accompanied by at least four of the following symptoms:Choking or smothering sensationsFears of losing control, dying, or going insaneNot all attacks or all people have the same symptomsThe sense of danger and physical discomfort the attacks bring is so intense that many interpret them as the precursors of a heart attack or stroke, or the product of a brain tumor. Consequently, many panic disorder sufferers show up in emergency rooms where doctors unfamiliar with the illness judge that the patient is in no danger and send them home. But eventually, I made myself take the subway, though I still experienced the attacks. The EKG showed nothing untoward; the emergency room doctor said to go home and get some rest, that he or she was probably only overtired. The jagged emotions seem like a dim memory until the next time. When another attack does come, the panic disorder sufferer naturally begins to search for a cause. Often, he or she will begin to avoid situations or places where episodes have occurred. He or she may stop going to the ballpark, or avoid driving or riding elevators, since these activities seem to be triggers. This paring away of accustomed patterns is called phobic avoidance. It may help temporarily with the fear of the attack and its accompanying loss of control, but it makes a normal home and work life nearly impossible. Untreated panic disorder can produce other side effects. Fear of the fear the attacks bring, or anticipatory anxiety, can be one unfortunate outgrowth. The sufferer never knows when another attack will come, and is always steeled for it. Studies have shown that agoraphobia, literally "fear of the marketplace," is often coupled with panic disorder. It can drive those with panic disorder to skirt public places, though paradoxically they fear being alone. This pattern may progress to the point that the panic disorder victim fears leaving his or her home without a trusted companion, or fears leaving home, period. Those who must leave the house for the office can also suffer front a sort of agoraphobia which leaves them shackled to their route between home and office, unable to deviate from their workaday pattern. Confined to such a limited lifestyle which puts so much strain on relations with friends and family, panic disorder sufferers also more easily become prey to depression and its complications than does the average person. Recent studies have suggested also that two out of three people with panic disorder also experience depression over their lifetime. Also, panic disorder sufferers often further complicate their illness with drug and alcohol abuse. This form of "self medication" is sadly ironic: researchers believe that drugs or alcohol themselves pull down mood and worsen anxiety, condemning the victim of panic disorder to a downward spiral of anxiety, depression, and more panic. Surveys have shown that more women than men are afflicted with panic disorder by a ratio of approximately two to one--and that panic disorder knows no racial, economic, or geographic boundaries. Because its victims often hide their illness and because healthcare professionals often do not diagnose it, it is difficult to gauge how widespread panic disorder is in the general population. In a recent study by the National Institute of Mental Health, 10 percent of those interviewed reported having had spontaneous panic attacks. The best recent estimate of those with panic disorder places the number of Americans suffering with panic disorder or phobias at 13 million. Apart front the very real suffering the disorder inflicts, the illness costs billions of dollars per year in the U. And as the disorder is more widely recognized and researched, those numbers may well climb. Researchers have found that panic disorder runs in families, a fact which supports the idea that the condition may pass genetically from generation to generation. To explore this possibility, scientists are pursuing several promising lines of biological study, looking into the brain for clues to the causes of panic disorder. Still another group is looking into the effect on the brain of various chemical compounds, such as sodium lactate and carbon dioxide. Many people who do not have panic disorder may have an occasional panic attack during periods of severe stress. But those with panic disorder have the attacks even after the stressful conditions have gone. The disorder typically begins when its victims are in their twenties. Often a serious event-such as the death of a parent or divorce will kick off the first attack.

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