The sex toys

– “Doctor…My hubby gave me a dildo with a cute little tickling ear—such a sweetheart.”

When the time of Valentine’s Day came, most physicians would teasingly ask their lady patients if their “significant other” remembered the date. Usually they would start talking their heads off about beautiful flower bouquets, or bags of tasty chocolates or romantic dinners in smart restaurants. Or the three of them. But they would never dare to tell us what happened that night afterwards. Sometimes a giggle or a wink was all that we needed to know that they had had some fun; we never dared to ask for details.

Alicia X. is a very smart and gorgeous young clinical psychologist who happens to be my patient. She was never shy about her discussing her sexual preferences and frustrations, being a source of inspiration for many of the article in this series. Two years ago, she found her “soul mate”, a very nice businessman who adores her and literally lives for her and their one-year old daughter. Being an outspoken feminist, she proudly tells everybody that wants to listen that he is “super in bed” because he knows how to engage in the necessary foreplay to excite all her senses. Last year she told me that he had given her some saucy lingerie. But this year he went a step further. Way further.

Unfortunately, the malicious double sexual discourse of the perennial patriarchal society—on one hand exposing us to the more vile forms of pornography in the media and on the other hand playing prudish when the time to discuss healthy sexual behavior in the public forum—has blurred the significance of “sensuality” in our media. It originally refers to using all our senses—vision, hearing, smell, taste and touching—to potentiate our sexual experiences in an innovative way. The over-reliance of males in the issue of “penetration” in our phalo-centric cultures is based on the subconscious masculine fear of “not being able to satisfy her” in the bed and fail as a partner. If they would only know that her sexuality is not only limited to her vagina but distributed all over her body.

The concept of “sex” involves much more that a ready penetration of a cavity and empowered women are determined to remind and/or teach their partners about mind-spiritual connections. The sexual act begins when someone looks at another person in a different, original way and then approaches him/her for further contact. The mellifluous chat, the open flirting, the occasional touch, the furtive kisses, the sharing of exciting cultural and gastronomic events are part of the act. The ladies are shedding their traditional timidity and asking for more romance, more eroticism. Better listen, guys.

The sex toys are part of that ensemble of additives to make the sexual act more enjoyable for both. The special oils for relaxing massages, the online stimulation programs, the vibrating ring to prolong the erection, the provocative lingerie in black or red, the masks, the various vibrators, etc. Even though many men still consider them an unwarranted intrusion in their intimacy, which can distract their partners from the “business at hand”, more women are demanding their step by step inclusion. As it has been for centuries, the ladies are the ultimate arbiters in the intimacy of the bedroom.

What do you want me to say? I still can’t figure out what that cute little ear is supposed to tickle…

What do you think? Please tell us.

Don’t leave me alone.

Reform at the NHS England

The recent overhaul of the American health care system, which has been inappropriately referred as “Obamacare” by the media, and the frantic efforts of the new American administration to dismantle it—so far unsuccessful but time will tell—has brought some forced comparison with other care systems; some policy pundits have insolently dubbed it as the “Anglicisation” of our highly fragmented health care delivery system.

Since the health care reforms of Premier John Major—who enacted the “internal market”—and Premier Tony Blair—who instituted the “patient choice”—the health policy experts in the United Kingdom have been talking non-stop about the ongoing “Americanisation” of their venerable National Health Service (NHS). In 1948, the UK authorities created a universal health care coverage for every Briton, who were mostly impoverished after the World War II and the loss of their colonies. Citizens and pundits alike have denounced those modernization drives as a “Trojan horse” to force the entry of the “private sector” in an extremely revered and popular British institution.

What the two health care systems have in common is the following: their citizens live longer and are consuming a higher percentage of public and private financial resources in a technologically-driven medicine. In the USA the Medicare and Medicaid systems have been slowly replacing the fee-for-service system for a more integrated and efficient system of “managed care” that must be accountable. In Britain, the timid introduction of some kind of accountable care has sparked a vivid rebuke of organized citizens groups and the media that have denounced it as illegal because voters had not approved it.

James Meeks wrote in the “London Review of Books” an excellent review of the present reform in the United Kingdom with the forthright description of two universe. “In universe one, the NHS will be upturned to give most of the healthcare people need at home or on their doorstep and admit to the big hospitals only patients with major trauma, or suffering diseases that demand intensive care, or complex surgical or biochemical expertise. Big hospitals are to become centers of research, high technology, rare skills and dramatic, life-saving interventions.” In contraposition to that ideal, clean environment the author describes the other universe. “In universe two a counter-reality prevails: the reality of winter, the reality of need, the reality of an ever increasing number of frail, elderly people converging on the help of last resort, the emergency hospital.”

In the United Kingdom the combination of a providential welfare state and a good universal health care system has led to the marked prolongation of life expectancy for men and women alike. However the entry into an ever older age has brought the emergence of “multiple co-morbidities” in their clinical condition. Nowadays a patient that has a peak of high blood pressure must be treated taking into consideration that he/she might be also diabetic, or suffering form renal diseases, or a neoplasia. As a result, efficient and comprehensive long-term care for the elderly and disabled is a high time and resources-consuming endeavor. Sadly, even though elderly people might elicit compassion and understanding at an individual or family level, they are mostly ignored by the younger generations that work and fill the purse with their salary deductions. That commiseration does not translate into the civic approval of more funding. Younger citizens are usually in a state of “self-denial” about their own future fragility in old age.

Meeks studied the reform in Leicestershire, a miniature expression of modern England: densely populated, a dynamic economy and a younger population, many of them immigrants and students. It’s on the south-eastern rim of the Industrial Revolution of the 19th century, it has three Labor elected representatives and it narrowly voted to stay (Remain) in the European Union. The counties surrounding Leicester are very different as they comprise extremely well-off areas where the country gentlemen live and run-down districts that could not recover from the modernization. It is a whiter, older world where the need for home health services and ancillary support is stronger. The Lansley reform—named after the Conservative health secretary Andrew Lansley—created seven local organizations as the point of delivery in Leicestershire.  The “Clinical Commissioning Groups” (CCG) are aggregation of general practitioners located at the city of Leicester and the east-west ends of the area. The Royal Infirmary Hospital, which has the largest Emergency department in England, is run by the “University Hospitals of Leicester Trust.” The “Leicestershire Partnership Trust” runs all the community care services, including Mental Health and the Prisons.

Meeks found that the authorities of Leicestershire have implemented a virtual system 256 bed “hospital” called “Intensive Community Support” (ICS) where the convalescent patients are being treated by nursing and ancillary personnel in their own residence. There is an integral, holistic approach to the patients that are discharged from the hospital as the home health personnel, social workers and ancillary personnel are being scheduled and supervised by the same administration. The author found that the altruistic objectives—like being able to access a local doctor until 8 PM seven days a week—are not completely attained, with some district areas worse than others. The push for cuts in services that are prodded by the central authorities of the NHS could not prosper.

Considering that the population of Britain is growing in overall number and longevity, there is dire financial need for more staff, more material resources, more distributive planning. Besides the demographic inflation, there is the salaries’ inflation to account for as the health care system is run by persons with increasing needs in a modern economy. In order to compete in a tight labor market for talent and expertise, the health care organizations must offer better benefits and good pay. The “Baumol cost disease”—named after the economist William Baumol—describes the asymmetry between industries like manufacturing that can be automated and require less workers with the ones like health care that cannot be readily automated and still require large number of employees.

Many citizens of modern societies like the UK and the USA (certainly not all and not in the same degree) are enjoying one of the biggest prolongations of their average life spans with an ensuing ability to continue enjoying their activities, including postponing their retirement and working into their late 70s. But they certainly are afflicted by chronic diseases like high blood pressure, diabetes, arthrosis, which require regular medical check-ups and proper long-term treatment. Young people will eventually reach that stage too and if they now refuse to fund the existing long term care services for elderly people, they will be dismantled by myopic bureaucrats that only know how to count beans. Watch out, Millennials. Those services take years to design and put up; they will not be available for you in your golden years if you don’t protect them now with your voices and votes. But there is a positive economic variable at play.  William Baumol considered that the efficiency savings in the manufacturing sector will eventually liberate more funds to invest in health care. Let’s hope that politicians don’t squander those funds.

What do you think? Please tell us.

Don’t leave me alone.




Addicted to sex

– “Doctor…Got to make love every night—my husband has to keep up with me.”

Solange X. is a gorgeous thirty something lady that has a loving husband and a small child, besides working as a busy manger in a local communications company. She consulted me a few months ago due to a painful bursitis in the right shoulder that she attributed to a fancy sexual pose she had tried with her partner a few days before. When I prescribed some anti-inflammatory medication and rest for a few days, she forthrightly told me that she would not stop her nightly risky maneuvering in bed.

The issue of “sex addiction” is being contested in professional circles at present, which led to a fight whether to include that entity in the DSM III; the lack of clear cut evidence finally tipped the balance against including it as a new diagnosis in it. An addiction implies the existence of two main factors, which are the following:

  1. The search for a compensation or pleasure
  2. The existence of a conflict surrounding this behavior

An addiction is different than an obsessive-compulsive behavior because in the latter there is not the acquisition of pleasure as the final goal. Some psychologists argue that in addictions, the abnormal behavior can produce physical/psychological harm. The obsession for food and gambling were recognized as abnormal clinical entities.

Dr. Walter Guedin, a psychiatrist specializing in Sexology in Buenos Aires said: “in the addiction to sex the desire is mixed with the impulse, pleasure with anxiety, the temptation with moral values, danger or the risk sensation with the self-preservation. The addiction to sex is an irrepressible, repetitive behavior that carries the stigma of guilt and sensation of void that appear once the sexual tension has come down.”

After patiently listening to Solange’s explanation, I looked into her eyes and said:

– “Do you lift you baby in your arms to play with him or look into his eyes?’

– “Of course, all the time… When I come back from work, it’s the first thing I do.”

– “Well, there you are…If you don’t wear a sling for a few days and avoid stressful situations for your right shoulder, you might not be able to do it in the future…”

She demurred for two seconds and then replied: “all right…I’ll follow your advice.”

What do you think? Please tell us.

Don’t leave me alone.

A new drug for progressive Multiple Sclerosis

Multiple Sclerosis is not a single pathological entity but rather two abnormal processes that advance in parallel yet inter-connected tracks and varying degrees of severity, which results in different clinical presentations. In the beginning the infiltrative inflammation predominates in the brain and spinal cord with the clinical imprimatur of relapses and remissions. Patients, who are usually young, have the illusion that once the inflammation process subsides, they would be disease-free for a long time.

However, a more sinister and crippling process has already started: degeneration. The clinical picture consists of progression with limiting sequelae like chronic pain and spasticity of upper and lower limbs. The available drugs targeted the first process but failed to address the second one. Until a new drug was studied: siponimod. Like fingolimod, it is a modulator of sphingoside-1-phosphate (SIP) receptors but it only selectively modulates types 1 and 5 receptors of the lymphoid tissue; the first one promotes the disposal of lymphocytes while the second one is stored in the CNS.

Kapos et al. collected more than 1600 patients from almost 300 clinical centers in the USA and Europe to study the administration of 2 mg of sipominod per day to half the cohort to compare it to the other half that only received a placebo for a median period of eighteen months. The principal studied index was “time to three-month confirmed disease progression” (CPD), which was defined as a 1.0 point increase in expanded Disability Status Scale (EDSS) score for the participants with moderate disability or 0.5 point increase for those with severe disability initially.

Only 26% of participants receiving siponimod had grave, prolonged disability compared to 32% of those receiving only the placebo; the drug had a hazard ration of 0.79 and a relative reduction of 21% of the risk to develop crippling symptoms. Once the study was finished all the participants were offered the chance to take it. Imaging studies showed a reduction from baseline in T2 lesion volume and the gadolinium-enhancing lesions. Moreover, those participants taking the drug had less decline in the brain volume between the 12th and 14th months compared to placebo.

Investigators are moderately optimistic about these results, but they point out that, in order to prevent the serious disabilities this disease provokes in young people, they must strive to intervene earlier in progressive forms of MS. Much, much earlier.

What do you think? Please tell us.

Don’t leave me alone.

Toxic feelings of guilt

– “Doctor…Whatever I do or say to my boyfriend is always wrong—I’m exhausted.”

Isabel X. is a gorgeous young graduate student that has had a longstanding conundrum. She fell in love with a dashing fellow student two years ago and they started living together six months ago. Initially she felt that her dream had come true: a handsome, intelligent and romantic guy. However, she found out that the pretty packaging was concealing a particular personality trait: narcissism.

It is easy for a woman to fall in love with a narcissistic man: they are so much fun as a company. They are very sociable, eager to meet new people, have wonderful conversations, show courtesy. However, there is a telltale sign that trouble lies ahead: they talk too much about themselves. Living with him under the same roof, Isabel found out that her partner was not listening to her. Worse, every time she opened her mouth to share something big or small, he interrupted her. Her emotional frustration was gnawing slowly but readily her self-esteem, which negatively affected her studies.

Her strong romantic bondage and high level of expectations for her partner, prodded Isabel to take his sickening attitude in stride, which was obviously worsened by her big fear of abandonment. Her girlfriends and her mother, who occasionally dropped by in her campus dorm apartment, got it right from the start; they all encouraged her to drop that relationship and clean her slate quickly. She continued to give, give, give…In return she was getting nothing except toxic feelings of guilt.

“Is it my fault?” “Should I talk differently?” “Am I asking for too much?” “Do I deserve him?”

Jeffrey E, Young said that the only way to break off negative life patterns is to re-evaluate your relationships and start to appreciate those persons, who, in spite of appearing boring, listen to us. Oftentimes a companion that sits down or snuggles in the sofa next to you is very precious. The always fun-always attractive-always romantic hero of so-called “chicks’ movies” is a total fake. Wait a minute. With my daughter, we did enjoy watching the film “Leap Year” where the central character found out that the rough Irish guy she met on vacation was better than her NY boyfriend. Amy Adams fortunately found out that Matthew Goode was a better match for her. He listened.

Isabel did ask me what to do. My answer: “move out immediately and cut all contact with him.” When she left my office, I didn’t think that she was going to follow my tough advice. She did. She later told me that the same evening she said to him; “we need to talk.” Like Nora had done before in “House of dolls”. Her boyfriend became very aggressive and refused to even listen to her. But she stood firm. In the morning she gathered her belongings and moved out with a girlfriend living in the same dorm. She re-connected with her network of friends and went back home for a long week-end. Despite his frantic attempts to contact her, she was shielded by her circle of friends and family.

After a month, she finally accepted that she had engaged in an extremely damaging relationship. She vowed never to repeat the same mistake. She found a boyfriend who was willing to listen. Exhilarated with her blessed happiness, she learned how to cook. Compared to the sorry version of herself I had witnessed, she was simply radiant.

And she brought me delicious cookies. What do you want me to say? If most men only got a glimpse of the strategic advantage bestowed unto others by just listening more.

What do you think? Please tell us.

Don’t leave me alone.


Hearing loss and Cognitive decline

They say that we wouldn’t be able to tolerate the smell of the Middle Ages, a pervasive stench produced by the dumping of all the raw sewage in the small, congested streets; citizens had the chance to cloister themselves in their homes with incense and spices. But those same citizens wouldn’t be able to function anywhere with our noise pollution.

In our modern hyper-connected age, there are many causes of hearing loss due to the constant bombardment of noise in the public media that is transmitted to people’s personal devices, inside and outside their homes. A significant hearing loss (more than 20 decibels) manifested in the elevation of the threshold for pure detection affects almost half of people over 65 years old and two thirds of those above 80. The loss of hearing does affect the mental capacity of patients, being an important dementia cause. If the hearing loss is greater than 25 decibels, the patient will age approximately 7 years more.

The sense of Hearing has two main neurological components, which are the following:

  1. Peripheral Hearing: it includes all the sensory elements of the outer and middle ear that receive and transmit the encoded sensations to the Central Nervous System.
  2. Central auditory processing (CAP); it includes all the CNS structures involved in the hearing pathway that ends up in the Temporal lobe.

From the paraphernalia of sounds that we are being exposed to on a daily basis, our nervous system must separate the important sounds and “classify” them before their distribution to the brain; our encoding system allows us to differentiate the pitch, rhythm and timbre of the incoming noises. As we age the central processing of sounds progressively deteriorate and affects a majority of people. A clinical study involving 120 participants with a mean age of 70 years old found that the cognitive decline was related to understanding of speech in noise and not the peripheral pick-up of sounds.

RK Gurgel et al. studied a large cohort of 4,545 individuals with a mean age of 75 years old and no clinical signs of any cognitive decline; the clinical examination showed that 836 individuals had baseline hearing loss. All the study participants were subsequently followed for almost 12 years. In the hearing loss group 16% eventually showed signs of cognitive decline and in the normal group 12% did; the mean time to show signs was 10.3 years in the first group and 11.9 in the other. An additional 10% of the patients with hearing loss that developed cognitive decline eventually showed signs of Alzheimer’s disease, compared to 8% of those that did not have any hearing loss.

Lin MY et al. found that study participants with hearing loss had a significant increase in cognitive decline—almost 40% in some cases—and almost a quarter of those with abnormal hearing did develop cognitive decline in the follow-up period of six years; those with hearing loss took on average 7.7 years to show intellectual deterioration compared to 11 years for those without it. It’s a self-sustaining vicious circle as another study showed that dementia worsens hearing loss.

Jonathan Peelle et al showed that impaired hearing capacity is associated with the decrease in the critical volume of gray matter in the auditory cortex bilaterally, as well as the one of the prefrontal cortex; as the study was not longitudinal, it is not clear whether these finding were before or after the loss. Profant et al., using the novel radiological techniques of MR morphometry and Diffuse tensor imaging (DTI),  showed that hearing loss can produce deterioration of the white matter coming in and out of the auditory cortex, suggesting that age alone is not the only factor in cognitive decline; the hearing loss can lead to sensory deprivation, wrong information processing and anatomy changes.

What do you think? Please tell us.

Don’t leave me alone.

Bodily image and self-esteem

– “Doctor…I don’t want him to see my belly scars—I undress quickly and plunge in bed.”

Sandra X.  is an old acquaintance of this page already. She’s the brave lady that decided to set up a painter’s atelier in Miami’s Wynwood section and has a boyfriend who’s 20 years younger. However, she can’t help feeling a little ashamed of the small striate that she has in her belly after having had two children, a common anatomical hallmark that post-partum women carry in earnest. Even for a daring lady like herself, who has defied many social conventions, she cannot detach herself completely from the ridiculously perfect image of women’s bodies that social media promotes.

Women have a much more integrated, holistic vision of their own bodies than men usually do. They can scan themselves quickly in the mirror and soon detect “something that’s not quite right.” It could be the color of their hair, the size of one of their breasts, the symmetry of their thighs, etc. As a result, they will try to conceal that supposedly “weak aesthetic feature” and worry about it. The hurried pace of modern life and the oftentimes erratic choice of sexual partners will enable those ladies to avoid the necessary sexual foreplay altogether and jump straight into “the business.”

Institutes like the “Body Positive” in Berkeley, California, have been teaching women for years how to accept their own bodies, defects included, and develop a positive social attitude. We already discussed in our previous article called “The Fat Girl” how the social pressure to conform to a certain idealized, trimmed version of the feminine body, which is a relatively recent enslaving tool of the patriarchal society to keep women at bay, can seriously harm those that don’t conform to it. A cowered, uninformed and diminished  individual is much easier to manipulate for a tyranny’s oppression. The upcoming new film based on Ray Bradbury’s “Fahrenheit 451” is a testimony to that resilient truth.

Dr, Walter Ghedin, a Buenos Aires psychiatrist specializing in Sexology and a dear friend, said: “all the body can be an object of internalized critique and camouflaging. When the malaise progresses, it is impossible to remain open and free to engage in a sexual encounter. The experience of undressing together (a practice that is generally being dropped due to the daily haste), of touching ourselves, of allowing us the time to discover our bodies, becomes a feared event that must be avoided, recruiting the bed sheets and the bedroom darkness as our allies in the conceit.” He claims that our attention becomes fixated “in that thing” and distracts us from enjoying sex. Our anticipated anxiety about our “defect” makes us second guess our partner’s thinking as we feel that he/she/sie shares our obsession and does not speak out in order to avoid hurting us more. Unfortunately avoiding this touchy subject can only prolong the agony for the concerned partner.

What do you want me to say? Even though I have been overweight for many years already, I never gave it too much thinking at the time of sexual arousal…We, men, are definitely less complicated.

What do you think? Please tell us.

Don’t leave me alone.