• Routine
• Personality and Conduct
• The results:
• Instincts and Drives
• Object Relations
• Sample sentences of narcissists:
• Functioning and Performance
• Locations and Environment

Routine

I hate routine. When I find myself doing the same things over and over again, I get depressed. I oversleep, overeat, overdrink and, in general, engage in addictive, impulsive and compulsive behaviors. This is my way of re-introducing risk and excitement into what I (emotionally) perceive to be a barren life.

The problem is that even the most exciting and varied existence becomes routine after a while. Living in the same country or apartment, meeting the same people, doing essentially the same things (though with changing content)- all "qualify" as stultifying rote.

I feel entitled to more. I feel it is my right - due to my intellectual superiority - to lead a thrilling, rewarding, kaleidoscopic life. I feel entitled to force life itself, or, at least, people around me - to yield to my wishes and needs, supreme among them the need for stimulating variety.

This rejection of habit is part of a larger pattern of aggressive entitlement. I feel that the very existence of a sublime intellect (such as myself) warrants concessions and allowances. Standing in line is a waste of time best spent pursuing knowledge, inventing and creating. I should avail myself of the best medical treatment proffered by the most prominent medical authorities - lest the asset that is I be lost to Mankind. I should not be bothered with proofreading my articles (or even re-reading them) - these lowly jobs best be assigned to the less gifted. The devil is in paying precious attention to details.

Entitlement is sometimes justified in a Picasso or an Einstein. But I am neither. My achievements are grotesquely incommensurate with my overwhelming sense of entitlement. I am but a mediocre and forgettable scribbler who, at the age of 39, is a colossal under-achiever, if anything.

Of course, the feeling of supremacy often serves to mask a cancerous complex of inferiority. Moreover, I infect others with my projected grandiosity and their feedback constitutes the edifice upon which I construct my self esteem. I regulate my sense of self worth by rigidly insisting that I am above the madding crowd while deriving my narcissistic supply from this very thus despised source.

But there is a second angle to this abhorrence of the predictable. As a narcissist, I employ a host of Emotional Involvement Prevention Mechanisms (EIPM). Despising routine and avoiding it is one of these mechanisms. Their function is to prevent me from getting emotionally involved and, subsequently, hurt. Their application results in an "approach-avoidance repetition complex". The narcissist, fearing and loathing intimacy, stability and security - yet craving them - approaches and then avoids significant others or important tasks in a rapid succession of apparently inconsistent and disconnected behaviours.

Here is a partial (and truncated) list of other EIPMs. In this text - "objects" means "others".

From "Malignant Self Love - Narcissism Revisited":

"Emotional Involvement Preventive Measures

Personality and Conduct

• Lack of enthusiasm, anhedonia, and constant boredom.
• A wish to "vary", to "be free", to hop from one subject matter or object to another.
• Laziness, constantly present fatigue.
• Dysphoria to the point of depression - leads to reclusiveness, detachment, low energies.
• Repression of the affect and uniform emotional tint.
• Self-hatred disables capacity to love or to develop emotional involvement.
• Externalised transformations of aggression:
• Envy, rage, cynicism, vulgar honesty
• (all lead to dis-intimization and distancing and to pathological emotional and sexual communication)...
• Narcissistic compensatory and defence mechanisms: ...
• Grandiosity and grandiose fantasies
• (Feelings of) uniqueness

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• Lack of empathy, or the existence of functional empathy, or empathy by proxy
• Demand for adoration and adulation
• A feeling that he deserves everything ("entitlement")
• Exploitation of objects
• Objectification/symbolization (abstraction) and
• Fictionalisation of objects
• Manipulative behaviours
  (Using personal charm, ability to psychologically penetrate the object, ruthlessness, and knowledge and information regarding the object obtained, largely, by interacting with the object)
• Intellectualisation through generalization, differentiation and categorization of objects.
• Feelings of omnipotence and omniscience.
• Perfectionism and performance anxiety (repressed).
• These mechanisms lead to emotional substitution (adulation and adoration instead of love),
• to the distancing and repulsion of objects,
• to dis-intimization (not possible to interact with the "real" Narcissist).

The results:

• Narcissistic vulnerability to narcissistic injury
• (More bearable than emotional vulnerability and can be more easily recovered from)
• "Becoming a child" and infantilism
  (The narcissist's inner dialogue: No one will hurt me, I am a child and I am loved without any reservations, judgement, or interests)
• Such expectations for unconditional love and acceptance do not exist among adults and they constitute a barrier to mature, adult relationships.
  Intensive denial of reality
  (perceived by others as innocence, naiveté, or pseudo-stupidity).
• Constant lack of confidence concerning matters not under full control leads to hostility towards objects and towards emotions.
• Compulsive behaviours intended to neutralize a high level of anxiety and compulsive seeking of love substitutes (money, prestige, power)...

Instincts and Drives

• • Sexual abstinence, low frequency of sexual activity lead to less emotional involvement.
  • Frustration of emotional objects through sex avoidance encourages abandonment by the object.
  • Sexual dis-intimization by preferring autoerotic, anonymous sex with immature or incompatible objects
    (who do not represent an emotional threat or demands).
  • Sporadic sex with long intervals and drastic alterations of sexual behaviour patterns.
  • Dissociation of pleasure centres:
  • Pleasure avoidance (unless "for and on behalf" of the object).
  • Refraining from child rearing or family formation.
  • Using the object as an "alibi" - extreme marital and monogamous faithfulness, to the point of ignoring all other objects leads to object inertia.
  • This mechanism defends the Narcissist from the need to make contact with other objects.
  • Sexual frigidity with significant other and sexual abstinence with others.

Object Relations

• Manipulative attitudes, which in conjunction with feelings of omnipotence and omniscience, create a mystique of immunity.
• Partial reality test.
• Social friction leads to social sanctions (up to imprisonment).
• Refraining from intimacy.
• Absence of emotional investment.
• Reclusive life, avoiding neighbours, family (both nuclear and extended), spouse and friends.
• The narcissist is often a schizoid (see FAQ67)
• Active misogyny with sadistic and anti-social elements.

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• Narcissistic dependence serves as substitute for emotional involvement.
• Immature emotional dependence and habit
• Object interchangeability
  (dependence upon AN object - not upon THE object)...
• Limitation of contacts with objects to material and "objective" transactions.
  The Narcissist prefers fear, adulation, admiration and
• Narcissistic accumulation to love.
• To the narcissist, objects have no autonomous existence except as PNSS and
• SNSS (=primary and secondary sources of narcissistic supply).
  Knowledge and intelligence serve as control mechanisms and extractors of adulation and attention (=Narcissistic Supply).
• The Object is used to recreate early life conflicts:
• The Narcissist is bad and asks to be punished anew and to have confirmation that people are angry at him.
• The object is kept emotionally distant through deterrence and is constantly tested by the Narcissist who reveals his negative sides to the object.
• The aim of negative, off putting behaviours is to check whether the Narcissist's uniqueness will override and offset them in the mind of the object.
• The object experiences emotional absence, repulsion, deterrence, and insecurity.
• It is thus encouraged not to develop emotional involvement with the Narcissist
  (emotional involvement requires a positive emotional feedback).
• The erratic and demanding relationship with the Narcissist is experienced as a burden.
• It is punctuated by a series of "eruptions" followed by relief.
• The Narcissist is imposing, intrusive, compulsive, and tyrannical.
• Reality is interpreted cognitively so that negative aspects - real and imagined - of the object will be highlighted.
• This preserves distance, fosters uncertainty, prevents emotional involvement and activates Narcissistic mechanisms (such as grandiosity) which, in turn, increase the repulsion and the aversion of the partner.

Sample sentences of narcissists:

• • "The object is not as (some trait) as the Narcissist is",
  • "She is boring",
  • "She is dangerous because she is.",
  • "A stable relationship cannot be formed because."
  • Another interpretation offered by the narcissist:
  • The Narcissist chose the object because of an error/circumstances/pathology/loss of control/immaturity/partial or false information, etc.

Functioning and Performance

• A grandiosity shift:
• A preference to be emotionally invested in grandiose professional fantasies in which the Narcissist does not have to face a practical, professionally rigorous and constant path.
• The Narcissist avoids success in order to avoid emotional involvement and investment.
• He shuns a success which obliges him to invest and to identify himself with some goal and emphasizes areas of activity in which he is unlikely to succeed.
• The Narcissistic ignores the future and does not plan.
• Thus he is never emotionally committed.
• The Narcissist invests the necessary minimum in his job (emotionally).
• He is not thorough and under-performs, his work is shoddy and defective or partial.
  He evades responsibility and tends to pass it on to others while exercising little control.
• His decision making processes are ossified and rigid
• (He presents himself as a man of "principles" - usually his whimsical moods).
• The Narcissist reacts very slowly to a changing environment (change is painful).
• He is a pessimist, knows that he will lose his job/business - so, he is constantly engaged in seeking alternatives and constructing plausible alibis.
  This yields a feeling of temporariness, which prevents engagement, involvement, commitment, dedication, identification and emotional hurt in case of change or failure.
• The alternative to a spouse:
  Solitary life (with vigorous emphasis on PNSS) or another partner.

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• This frequent change of vocations prevents the Narcissist from having a clear career path and annuls the need to persevere.
• All the initiatives adopted by a Narcissist are egocentric, sporadic and discrete.
• They focus on an aspect of the Narcissist, are randomly distributed in space and in time, and do not form a thematic or other continuum - they are not goal or objective oriented).
• Sometimes, as a substitute, the Narcissist engages in performance shifting:
  The construction of imaginary, invented goals with no correlation with the real world - and their attainment.
• To avoid facing performance tests and to maintain grandiosity and uniqueness the Narcissist refrains from acquiring skills and training (driving licence, technical skills, any systematic - academic or non-academic - knowledge).
• The Child in the narcissist is reaffirmed this way - because these are adult activities and attributes that are avoided.
• The gap between the image projected by the Narcissist (charisma, unusual knowledge, grandiosity, fantasies) and his actual achievements - create in him permanent feelings that he is a crook, a hustler, living an unreal life in a movie-like setting.
• This gives rise to ominous sensations of threat and, concurrently, to compensating feelings of immunity.
• The Narcissist is forced to become a manipulator.

Locations and Environment

• • A prevailing feeling of not belonging and of detachment.
  • Bodily discomfiture
    (the body feels as depersonalised, alien and a nuisance, its needs are totally ignored, its signals re-routed and re-interpreted, its maintenance neglected)
  • Distance from the political communities which the Narcissist inhabits (neighbourhood, city, state), his religion, his ethnic background, his friends.
  • He often adopts the stance of the "scientific observer".
  • This is Narcissistic Detachment - the feeling the Narcissist has that he is a director or an actor in a movie about his life.
  • The Narcissist avoids "emotional handles": photographs, music identified with a certain period in his life, places, people, mementoes and emotional situations.
  • The Narcissist lives on borrowed time in a borrowed life.
  • Every place and time period are but transitory (sufficient but not necessary) and lead to the next, unfamiliar environment.
  • The Narcissist feels that the end is near.
  • He lives in rented apartments, is an illegal immigrant in many countries, works without the necessary permits and licenses, is fully mobile on a short notice, does not buy real estate or immovables.
  • He travels light and he likes to travel. He is peripatetic and itinerant.
  • The Narcissist cultivates feelings of incompatibility with his surroundings.
  • He considers himself superior to others and keeps criticizing people, institutions and situations.
  • The above behaviour patterns constitute a denial of reality.
  • The Narcissist defines a rigid, impenetrable, personal territory and is physically revolted when it is breached."

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next: Wasted Lives: Spending Time With A Narcissist

• Watch the video on Differences Between Healthy Daydreaming and Grandiosity

Sometimes I find myself bemused (though rarely amused) by my own grandiosity. Not by my fantasies - they are common to many "normal people".

It is healthy to daydream and fantasize. It is the antechamber of life and its circumstances. It is a process of preparing for eventualities, embellished and decorated. No, I am talking about feeling grandiose.

This feeling has four components.

OMNIPOTENCE

I believe that I will live forever. "Believe" in this context is a weak word. I know. It is a cellular certainty, almost biological, it flows with my blood and permeates every niche of my being. I can do anything I choose to do and excel in it. What I do, what I excel at, what I achieve depends only on my volition. There is no other determinant. Hence my rage when confronted with disagreement or opposition - not only because of the audacity of my, evidently inferior, adversary. But because it threatens my world view, it endangers my feeling of omnipotence. I am fatuously daring, adventurous, experimentative and curious precisely due to this hidden assumption of "can-do". I am genuinely surprised and devastated when I fail, when the Universe does not arrange itself, magically, to accommodate my unlimited powers, when it (and people in it) does not comply with my whims and wishes. I often deny such discrepancies, delete them from my memory. As a result, my life is remembered as a patchy quilt of unrelated events.

OMNISCIENCE

Until very recently, I pretended to know everything - I mean EVERYTHING, in every field of human knowledge and endeavour. I lied and invented to avoid proof of my ignorance. I pretended to know and resorted to numerous subterfuges to support my God-like omniscience (reference books hidden in my clothes, frequent visits to the restroom, cryptic notation or sudden illness, if all else failed). Where my knowledge failed me - I feigned authority, faked superiority, quoted from non-existent sources, embedded threads of truth in a canvass of falsehoods. I transformed myself into an artist of intellectual prestidigitation. As I advanced in age, this invidious quality has receded, or, rather, metamorphosed. I now claim more confined expertise. I am not ashamed to admit my ignorance and need to learn outside the fields of my self-proclaimed expertise. But this "improvement" is merely optical. Within my "territory", I am still as fiercely defensive and possessive as I have ever been. And I am still an avowed autodidact, unwilling to subject my knowledge and insights to peer scrutiny, or, for this matter, to any scrutiny. I keep re-inventing myself, adding new fields of knowledge as I go: finance, economics, psychology, philosophy, physics, politics... This crawling intellectual annexation is a round about way of reverting to my old image as the erudite "Renaissance Man".

 

OMNIPRESENCE

Even I - the master of self-deception - cannot pretend that I am everywhere at once in the PHYSICAL sense. Instead, I feel that I am the centre and the axis of my Universe, that all things and happenstances revolve around me and that disintegration would ensue if I were to disappear or to lose interest in someone or in something. I am convinced, for instance, that I am the main, if not the only, topic of discussion in my absence. I am often surprised and offended to learn that I was not even mentioned. When invited to a meeting with many participants, I assume the position of the sage, the guru, or the teacher / guide whose words survive his physical presence. My books, articles and web sites are extensions of my presence and, in this restricted sense, I do seem to exist everywhere. In other words, I "stamp" my environment. I "leave my mark" upon it. I "stigmatise" it.

NARCISSIST: THE OMNIVORE (PERFECTIONISM and COMPLETENESS)

There is another "omni" component in grandiosity. The narcissist is an omnivore. It devours and digests experiences and people, sights and smells, bodies and words, books and films, sounds and achievements, his work and his leisure, his pleasure and his possessions. The Narcissist is incapable of ENJOYING anything because he is in constant pursuit of the twin attainments of perfection and completeness. Classic narcissists interact with the world as predators would with their prey. They want to do it all, own it all, be everywhere, experience everything. They cannot delay gratification. They do not accept "no" for an answer. And they settle for nothing less than the ideal, the sublime, the perfect, the all-inclusive, the all-encompassing, the engulfing, the all-pervasive, the most beautiful, the cleverest, the richest. The narcissist is shattered by discovering that a collection he possesses is incomplete, that his colleague's wife is more glamorous, that his son is better than he in math, that his neighbour has a new, impressive car, that his roommate got promoted, that the "love of his life" signed a recording contract. It is not plain old jealousy, not even pathological envy (though it is definitely a part of the psychological make-up of the narcissist). It is the discovery that the narcissist is NOT perfect, or ideal, or complete - that does him in.

 

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next: Narcissists and the Entitlement of Routine

In-depth look at what causes ADHD including: deficiency in neurotransmitters, genetics, brain abnormalities, environmental agents plus food additives and sugar.

Although the exact causes of ADHD are unknown, it is most likely caused by an interaction of genetic, environmental, and nutritional factors, with a strong focus on the interaction of multiple genes (genetic loading) that together cause ADHD.

The Role of Neurotransmitters in Attention Deficit Disorder

There is some evidence that people with ADHD do not produce adequate quantities of certain neurotransmitters, among them dopamine, norepinephrine, and serotonin. Some experts theorize that such deficiencies lead to self-stimulatory behaviors that can increase brain levels of these chemicals (Comings DE et al 2000; Mitsis EM et al 2000; Sunohara GA et al 2000).

Epinephrine
Epinephrine activation of receptors on the cranial vagus nerve increases the release of central norepinephrine and has been shown to enhance memory formation. Patients with ADHD have been shown to have a reduced urinary epinephrine level. Contrary findings are seen in patients with anxiety or PTSD. Given the high incidence of anxiety within ADHD patients as well as the increased risk of accident and injury, testing of epinephrine in ADHD patients should consider these other factors in order to have a better understanding of the role of epinephrine in ADHD.

Dopamine
ADHD is believed to be in part the result of a reduced or hypodopaminergic state. In conjunction with this assumption are the needs for stronger and less delayed behavioral reinforcement. Dopamine is involved in the reward cascade and the increased reinforcement threshold may be a manifestation of the hypodopaminergic state. Children with ADHD have displayed normal task performance under conditions of high incentive, but deficient performance under conditions of low incentive. Methylphenidate is believed to be beneficial in ADHD in part due to its ability to enhance dopamine signaling and therefore may enhance a deficient reward system in ADHD patients. Like many parameters that affect cognitive performance, dopamine levels also display an inverted U-shaped curve when plotted against factors like impulsivity.

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The development of the dopamine system prior to and during early adolescence is quite rapid, while the development of the serotonin system during this same time remains steady. A relative deficit in dopamine maturity would be concordant with an increased impulsivity and increased reward threshold seen in ADHD.

A delayed rate of brain development in ADHD is also supported by studies that find patients have increased level of delta and theta brain wave activity compared to controls. Delta and theta brain wave activity normally decreases until adulthood. As such, increased delta and theta wave brain activity can be an indicator of slowed brain maturity. Differences in the rate of serotonin and dopamine system development also may explain why significant numbers of children outgrow their ADHD symptoms.

Norepinephrine
Norepinephrine is an excitatory neurotransmitter that is important for attention and focus. Norepinephrine is synthesized from dopamine by means of the enzyme dopamine beta-hydroxylase, with oxygen, copper, and vitamin C as co-factors. Dopamine is synthesized in the cytoplasm, but norepinephrine is synthesized in the neurotransmitter storage vesicles.; Cells that use norepinephrine for formation of epinephrine use SAMe as a methyl group donor. Levels of epinephrine in the CNS are only about 10% of the levels of norepinephrine.

The noradrenergic system is most active when an individual is awake, which is important for focused attention. Elevated norepinephrine activity seems to be a contributor to anxiousness. Also, brain norepinephrine turnover is increased in conditions of stress. Interestingly, benzodiazepines, the primary anxiolytic drugs, decrease firing of norepinephrine neurons.

PEA
PEA (phenylethylamine) is an excitatory neurotransmitter that tends to be lower in patients with ADHD. Studies that tested urine levels of PEA in subjects with ADHD during treatment with stimulants (methylphenidate or dextroamphetamine), found that the levels of PEA were increased. Additionally, studies report that the efficacy of the treatment correlated positively with the degree to which urinary PEA increased.

Serotonin
Many of the effects of serotonin occur due to its ability to modify the actions of other neurotransmitters. Specifically, serotonin regulates dopamine release. This is evident in the observation that antagonists of either the 5-HT2a or the 5-HT2c serotonin receptor will stimulate dopamine outflow while agonists inhibit dopamine outflow. Similarly, dopamine has a regulatory effect on serotonin and neonatal damage to the dopamine system has been shown to cause large increases in serotonin.

Aspects of the interaction between serotonin and dopamine are believed to affect attention. Evidence of this interaction is present in the observation that reduced serotonin synthesis impairs the positive effects of methylphenidate on learning. Meaning some aspects of methylphenidate's therapeutic effects require serotonin. Serotonin levels are significantly affected by stress and coping abilities combined with other environmental factors and the person's genetic make-up to determine serotonin activity.

Brain Structural Differences in Attention Deficit Hyperactivity Disorder

There may also be some structural and functional abnormalities in the brain itself in children who have ADHD (Pliszka SR 2002; Mercugliano M 1999). Evidence suggests that there may be fewer connections between nerve cells. This would further impair neural communication already impeded by decreased neurotransmitter levels (Barkley R 1997). Evidence from functional studies in patients with ADHD demonstrates decreased blood flow to those areas of the brain in which "executive function," including impulse control, is based (Paule MG et al 2000). There may also be a deficit in the amount of myelin (insulating material) produced by brain cells in children with ADHD (Overmeyer S et al 2001).

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Some prenatal factors that increase the risk of developing ADHD have been identified. These include complications during pregnancy that limit oxygen supply to the brain such as toxemia and eclampsia. Other factors during pregnancy that have an impact on normal prenatal development and increase the risk of a child developing ADHD include smoking and fetal alcohol syndrome.

Other factors, such as stress, significantly affect the way the brain functions. If the temperament of the individual under stress allows them to cope in a positive manner, stress can actually increase performance and health. If however, the temperament of the individual under stress is such that the individual does not cope with the stress, the adaptive changes that allow the body to enhance its performance and stress may fail to function. This may lead to either an inability of the body to compensate or the inactivation of some neurological systems. Alternatively, neurological systems may become chronically elevated. In either case, the altered functions of these regions may underlie clinical symptoms.

Genetics and ADHD

Attention disorders often run in families, so there are likely to be genetic influences. Studies indicate that 25 percent of the close relatives in the families of ADHD children also have ADHD, whereas the rate is about 5 percent in the general population.⁶ Many studies of twins now show that a strong genetic influence exists in the disorder.

Researchers continue to study the genetic contribution to ADHD and to identify the genes that cause a person to be susceptible to ADHD. Since its inception in 1999, the Attention-Deficit Hyperactivity Disorder Molecular Genetics Network has served as a way for researchers to share findings regarding possible genetic influences on ADHD.

Environmental Agents

Studies have shown a possible correlation between the use of cigarettes and alcohol during pregnancy and risk for ADHD in the offspring of that pregnancy. As a precaution, it is best during pregnancy to refrain from both cigarette and alcohol use.

Another environmental agent that may be associated with a higher risk of ADHD is high levels of lead in the bodies of young preschool children. Since lead is no longer allowed in paint and is usually found only in older buildings, exposure to toxic levels is not as prevalent as it once was. Children who live in old buildings in which lead still exists in the plumbing or in lead paint that has been painted over may be at risk.

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Brain Injury

One early theory was that attention disorders were caused by brain injury. Some children who have suffered accidents leading to brain injury may show some signs of behavior similar to that of ADHD, but only a small percentage of children with ADHD have been found to have suffered a traumatic brain injury.

Food Additives and Sugar

It has been suggested that attention disorders are caused by refined sugar or food additives, or that symptoms of ADHD are exacerbated by sugar or food additives. In 1982, the National Institutes of Health held a scientific consensus conference to discuss this issue. It was found that diet restrictions helped about 5 percent of children with ADHD, mostly young children who had food allergies.³ A more recent study on the effect of sugar on children, using sugar one day and a sugar substitute on alternate days, without parents, staff, or children knowing which substance was being used, showed no significant effects of the sugar on behavior or learning.⁴

In another study, children whose mothers felt they were sugar-sensitive were given aspartame as a substitute for sugar. Half the mothers were told their children were given sugar, half that their children were given aspartame. The mothers who thought their children had received sugar rated them as more hyperactive than the other children and were more critical of their behavior.⁵

Source: NIMH ADHD Publication

next: Misdiagnosing ADHD

male sexual problems

You can begin by discussing your impotence with your family doctor. Many primary care physicians are not treating impotence in their practices. If your family doctor does not treat impotence, he or she will probably refer you to a urologist.

The physician who treats your impotence should first determine the cause of your impotence and then help you choose the simplest, safest and most effective treatment option for you.

You should know that difficulties in getting or keeping an erection is a common problem among men. The following treatments for impotence may be considered. Your doctor will be able to discuss these treatments with you in more detail and advise you on the advantages and disadvantages of each.

• Talk to your partner. Impotence won't go away unless you face up to it. If you're in an ongoing sexual relationship, then being open and honest with your partner can help identify any anxieties that might be causing the problem.
• Sex counseling or sex therapy. This can be effective for the small percentage of men who have psychological impotence. Sex counseling or sex therapy is most often successful when you have a cooperative partner willing to attend sessions with you.
• Lifestyle changes.Cutting out alcohol, tobacco and recreational drugs can lead to significant improvements.
• Vacuum device. This technique uses a mechanical device which creates a vacuum around the penis and causes it to enlarge in a way that is similar to a natural erection. In order to maintain the erection, a tension ring (similar to an elastic band) must be pushed onto the base of the penis. This stops the blood escaping from the penis too quickly, and with the tension ring in place, the erection can be maintained for up to 30 minutes.

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• Penile injection therapy. Medication is injected into the base of the penis, causing the penis to become hard almost immediately and the erection to last for one to two hours.
• Penile insertion (transurethral) therapy. This involves inserting an applicator containing a tiny pellet of medication into the end of the penis. Once the pellet is released, it causes an erection to develop over the next 10 to 30 minutes.
• Penile implants. This is a surgical procedure which involves the permanent insertion of a cylinder in the penis, which is connected by a tube to a pump in the scrotum. This procedure permanently alters the penis so that a natural erection will never again be possible.
• Drug therapy. Drug therapy for impotence (Viagra) has received a great deal of publicity. The drug works by opening up the blood vessels to the penis, so it may help patients who have trouble achieving erection due to lack of blood supply to the penis. It is not suitable for patients with heart problems.
• Hormone replacement therapy. In the form of testosterone injections can be effective for the 3-5% of men who are impotent due to a low level of male hormone.

New Drugs to Treat Impotence

Every man's worst nightmare is to realize, in the heat of a passionate moment, that he can't get an erection. Lucky for many men, we live in the twenty-first century and all the research in medicine is starting to pay-off. Today if you have erectile dysfunction, you have a variety of treatment options at your disposal, as well as quick fixer-upper drugs that can provide a temporary solution. We've already discussed the causes of impotence, treatment options, and where to find a specialist. But what many men want to know, is if there are treatment options available that don't require any surgery. The answer is "yes".

a gleam of hope

Thanks to modern medicine, a man can soon choose from a variety of new erection drugs. For men who have problems with their Willy, here is an introduction to the new impotence drugs awaiting approval from the FDA.

• Nasal Spray: This one gives new meaning to the expression, getting high from snorting. There is still no name for this product, developed by Nastech Pharmaceuticals. The spray works by delivering a dose of apomorphine into the nose. One snort allegedly gives you an erection in five minutes. One of the known side effects is nausea and because nasal delivery puts a large amount of the drug into the bloodstream at once, side effects worsen. You can expect to find it on the market by Spring 2002.

  • Vasomax: A pill that is supposedly safe for heart patients. This little pill by Zonagen Inc. contains phentolamine mesylate, a drug that dilutes the blood vessels in the penis. It works in about 20 to 30 minutes and it doesn't increase blood pressure. Human trials found that Vasomax caused erections in 40% of users. Some of the known side effects are nasal congestion and dizziness. You can expect to find it on the market by Spring 2001.

  • Alprox-TD: A topical gel made by NexMed Inc. contains alprostadil, a drug used in injectable impotence treatments. The drug works by allowing greater blood flow through the relaxation of the corpus cavernosum muscle. One of the perks to this gel is that most of the drug stays on your penis therefore minimizing side effects. Human trials found that the gel produced erections in 75% of men within 20 minutes. Some of the known side effects are a slight warming sensation in the penis. You can expect this gel on the market by Spring 2001.

  • Uprima: A tablet produced by TAP Pharmaceuticals contains apomorphine, a drug that is used in case of poisoning. It is placed under the tongue and begins working through a chemical reaction within the brain causing blood flow throughout the entire body. The drug is safer for heart patients and men who take anti-depressants. Human tests show that 58% of users had an erection within 20 minutes.

  • IC351: Created by Lilly Icos, the same makers of the famous Viagra pill. Viagra's big brother inhibits the phosphodiesterase type 5 enzyme, which constricts muscles and allows greater blood flow. The pill is still in its initial clinical trials. Some of the known side effects are the same as Viagra - headaches and flushes - but not as strong. It is still not recommended for men with heart conditions. You can expect to find it on the market by 2002.

These are just some of the drugs that are being developed to help men, especially those in their middle ages. But if you don't have an erectile dysfunction (why are you reading this article?), then you can at least use some of this information to make money on the stock market.

It is very important that you consult your doctor or a specialist before tying any of these new miracle drugs. For more information about impotence, check this out.

next: The Truth About Impotence

teenage sex

It's important to be informed about sexual health issues, even if you're not having sex right now, and if you are, then you need to arm yourself with some critical facts! Here you'll find plenty of info on how to protect yourself from getting pregnant, what to do if you think you're pregnant, what to do if you've had unprotected sex (or sex in which your method of birth control failed) in the last 72 hours, and where to go for help.

Birth Control Misinformation

There are a lot of myths and misinformation out there about protecting yourself from pregnancy. If you are considering any of these, forget about it. They DON'T work!

• Having intercourse during your period:
  First of all, just because you're bleeding doesn't mean you're having your "true" period; some women bleed during ovulation. And it's often hard to predict when you'll ovulate. So you'd better use protection whenever you have intercourse, all month long. (Sex during your period is also a riskier time for HIV transmission.)
• Peeing after intercourse:
  An old folks' tale! Urinating after sex does nothing to protect against pregnancy because women do not urinate out of their vaginal opening. So, although the urinary opening is near the vagina (just above it), urinating will not flush sperm out of the vaginal opening.
• Douching:
  Rather than rinsing sperm out of the vagina, douching could actually send them swimming upstream towards an egg. (It can also increase the risk of infection.) All in all, a bad idea!

Birth Control Options

Birth Control Pills

• Concept: A woman takes a pill that contains artificial hormones - either a combination of estrogen and progestin, or a progestin-only pill - every day. The pill works by preventing ovulation, increasing cervical mucus to block sperm, and creating a thin, unfriendly uterine environment.

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• Success Rate: With typical use, five women in 100 become pregnant in one year. With perfect use, less than one woman in 100 will become pregnant in one year.
• Positives: If taken consistently and correctly, the pill provides non-stop protection from pregnancy, can make a woman's periods more regular, reduce cramps, and shorten or lighten a woman's period.
• Negatives: Offers no protection against STDs including HIV; can cause side effects such as nausea, headaches and moodiness. Also, you need to remember to take the pill every day, and if you miss two or more pills in a cycle, or you are late starting a new cycle of pills, you should strongly consider using a back-up contraceptive until you have taken seven consecutive pills.
• Where to Get It: Through a prescription from a health care provider; the cost runs $15 to $40 a month depending on the pill brand, plus the cost of the visit to your health care provider. (Many clinics also have sliding scale fees, meaning you pay based on what you can afford.)

Cervical Cap

• Concept: A woman uses spermicide to coat the inside of this silicone or latex thimble-shaped device. Then she inserts it to the back of her vagina so that it suctions over the cervix, where it blocks sperm.
• Success Rate: With typical use, 20 women out of 100 become pregnant in one year. With perfect use, nine women out of 100 become pregnant in one year.
• Positives: It can provide continuous protection for 48 hours, no matter how many times you have intercourse (unlike the diaphragm, additional spermicide is not needed for additional acts of intercourse).
• Negatives: Won't protect effectively against most STDs, including HIV; can increase the risk of urinary tract infections and toxic shock syndrome; it only comes in four sizes so it may not be an option for everyone. Also, it has to stay in place for six hours after the last act of intercourse.
• Where to Get It: Through a prescription from a health care provider; the cost is about $35 to $60 plus the cost of spermicide, and the exam and fitting for the cervical cap. Many clinics also have sliding scale fees, meaning you pay based on what you can afford.

Condom - Female

• Concept: A thin polyurethane sheath, shaped like a small pouch with flexible rings at each end. The ring at the closed end holds the pouch in place inside the vagina, while the ring at the open end remains outside the vagina. The pouch collects semen and prevents it from entering the vagina.
• Success Rate: With typical use, 21 out of 100 women will become pregnant. With perfect use, five out of 100 will become pregnant.
• Positives: Protects against STDs, including HIV, and you can get it without a prescription. Also, you can insert it up to eight hours before having intercourse. If you are allergic to latex, this polyurethane condom is a good alternative.
• Negatives: The outside ring can slide inside the vagina during intercourse; also, caution should be used to make sure the man's penis doesn't slip around the side of the condom. Can be awkward to use at first; must be removed right after intercourse, before you stand up, to prevent semen leakage.
• Where to Get It: Buy it at drugstores or supermarkets or get it from family planning clinics; the cost, $2-$4 each.

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Condom - Male

• Concept: A polyurethane or latex sheath (rubber) covers the penis and collects the semen, preventing sperm from entering a woman's vagina. There are animal skin condoms available; however, unlike latex or polyurethane condoms, they do not provide protection from STDs, including HIV.
• Success Rate: With typical use, 14 women in 100 will become pregnant in one year. With perfect use, three women in 100 will become pregnant in one year.
• Positives: It provides good protection against most STDs, including HIV, the virus that causes AIDS. Plus, it's cheap, easy to carry around, and can be bought at any drugstore without a prescription.
• Negatives: It can break especially if it's not put on correctly; likewise, it can leak if not withdrawn carefully. Latex condoms must not be used with any oil-based lubricants like vaseline or massage oil. And some people may experience allergies to latex condoms.
• Where to Get It: At drugstores and supermarkets; costs anywhere from 50 cents and up to several dollars a piece depending on the brand and style. They are often free at family planning clinics.

Depo-Provera

• Concept: A woman gets an intramuscular shot of the artificial hormone progestin every three months, which keeps her from getting pregnant.
• Success Rate: Less than one woman in 100 will become pregnant in a year using this method.
• Positives: Once you get the shot, you don't have to think about birth control for three months.
• Negatives: Offers no protection against STDs, including HIV; also, may cause weight gain, irregular periods, and depression.
• Where to Get It: Requires a visit to your health care provider every three months for administration of the shot; the cost is about $35-$60 per shot, plus the cost of the office visit. Many clinics also have sliding scale fees, meaning you pay based on what you can afford.

Diaphragm

• Concept: A woman uses spermicide to coat this dome-shaped silicone or latex cup with a flexible rim. Then she inserts it to the back of her vagina so that it covers the cervix, where it blocks sperm.

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• Success Rate: With typical use, 20 women out of 100 become pregnant in one year. With perfect use, six women out of 100 become pregnant in one year.
• Positives: It can be put in place up to six hours before intercourse and can stay there for 24 (though fresh spermicide should be applied each time you have intercourse).
• Negatives: Won't protect effectively against most STDs, including HIV; can increase the risk of urinary tract infections and toxic shock syndrome; Can be messy (thanks to the spermicide) and clumsy to use until you get the hang of it. Also, it has to stay in place for six hours after the last act of intercourse and then needs to be washed thoroughly with soap and water.
• Where to Get It: Through a prescription from a health care provider; the cost is about $30 to $40 plus the cost of spermicide, and the exam and fitting for the diaphragm. Many clinics also have sliding scale fees, meaning you pay based on what you can afford.

IUD

• Concept: A small device that contains copper or a synthetic progestin hormone is inserted into a woman's uterus.
• Success Rate: Using a copper IUD, less than one woman in 100 will become pregnant in a year; using a progesterone IUD, two women in 100 will become pregnant.
• Positives: It provides very effective pregnancy protection and lasts a long time - a copper IUD can stay in place for up to ten years, a progesterone IUD lasts one year.
• Negatives: Doesn't protect against STDs, including HIV. With a copper IUD, spotting may occur between periods, periods may be heavier, and menstrual cramps may increase. A progesterone IUD is likely to cause spotting between periods and to reduce cramps and bleeding. If a woman using an IUD is exposed to infectious organisms, she risks having that infection spread upward to cause PID - pelvic inflammatory disease - a catch-all term for infections in the uterus, fallopian tubes, ovaries and/or pelvis. PID, in turn, can cause infertility. The IUD isn't recommended for women who haven't had children yet but want to in the future. Insertion can be painful.
• Where to Get It: From a health care provider; cost is about $150 to $300 for insertion and removal costs about $100. Many clinics also have sliding scale fees, meaning you pay based on what you can afford.

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Norplant

• Concept: Six small rods are inserted under the skin of a woman's upper arm, and these rods release the synthetic hormone progestin that prevents pregnancy.
• Success Rate: Less than one woman in 1,000 becomes pregnant in one year.
• Positives: It protects against pregnancy for up to five years -without your having to do a thing. Plus, it starts working within 24 hours of insertion.
• Negatives: Doesn't protect against STDs including HIV; may cause irregular periods, headaches, weight gain, and acne. Some women may be able to see the rods under the skin. Plus, having the rods removed can be a hassle.
• Where to Get It: Requires a visit with a health care provider; the cost for insertion is usually about $500 to $800, while removal usually costs more because it takes more time to do. Many clinics also have sliding scale fees, meaning you pay based on what you can afford.

Rhythm Method

• Concept: You keep track of a woman's menstrual cycle and have intercourse only during the "safe" (or infertile) days.
• Success Rate: Typical use is difficult to estimate with this method, but with perfect use, about nine women out of 100 become pregnant in one year.
• Positives: It's free and there are no devices to deal with. And there are no side effects (except having to go without intercourse for several days before and after ovulation).
• Negatives: Predicting when a woman will ovulate is not easy, and sperm can live inside a woman's body for several days. You have to keep careful track of your vaginal mucus, menstrual cycle, and/or body temperature to accurately track your fertility patterns beginning several months before you start relying on this method. Because of the difficulty of using this method, there are a lot of accidental pregnancies. Also, it doesn't protect against STDs, including HIV.
• Where to Get It: You will need good instruction - a class or clinician who can work with you - and several months of charting before you begin to rely on this method.

Spermicide

• Concept: A woman inserts a spermicide - available in foams, creams, jellies, films, or suppositories - deep into the vagina before sex to kill sperm before it can reach an egg.

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• Success Rate: With typical use, 26 women out of 100 will become pregnant in one year. With perfect use, six women out of 100 will become pregnant in one year.
• Positives: You can buy it at any drugstore - without a prescription; it can provide lubrication for intercourse.
• Negatives: Doesn't reliably protect against STDs, including HIV; plus, the chemicals can cause irritation or allergic reactions. Some spermicides such as nonoxynol-9 have been found to cause so much irritation to the vaginal walls that they can make the user more susceptible to STD and HIV infection. It's messy, and you need to follow directions for your product carefully - this may mean waiting after inserting spermicide before having intercourse, to allow time for it to dissolve and spread. You must insert more spermicide each time you have intercourse.
• Where to Get It: At drugstores or supermarkets. The cost is $9 to $12 for the spermicide and applicator; refills cost $4 to $8.

Tubal Ligation (female sterilization)

• Concept: In a surgical procedure, a woman's fallopian tubes are blocked or cut so that sperm and egg cannot unite.
• Success Rate: Less than one woman in 100 will become pregnant in a year.
• Positives: It's a permanent form of birth control; there are no lasting side effects.
• Negatives: Offers no protection against STDs, including HIV; if the procedure fails, there's an increased chance of tubal (ectopic) pregnancy (a dangerous situation in which a fertilized egg starts to develop in one of the fallopian tubes). Although it may be possible for the surgery to be reversed if a woman decides she wants to have another child, it's complicated, expensive, and doesn't always succeed. That's why the procedure is recommended only for women who have all the children they want, or who are absolutely sure they don't ever want to have children.
• Where to Get It: Talk to your health care provider; the cost is expensive, and depends on where you have the procedure done and how much your insurance will cover.

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Vasectomy (male sterilization)

• Concept: It's a surgical procedure for men, in which the tubes that transport sperm into semen are blocked or tied off.
• Success Rate: Less than one woman in 1,000 becomes pregnant in one year.
• Positives: It's a permanent form of birth control; there are no lasting side effects; it's safe, quickly performed, and cost-effective over the long run.
• Negatives: Doesn't protect against STDs, including HIV. Although reversal of the procedure is possible, it's expensive and not always successful. That's why the procedure is recommended only for men who have all the children they want, and are absolutely sure they do not want children in the future. After vasectomy it takes about 6 weeks for all sperm to be cleared, so another method of birth control must be used until a follow-up check shows no sperm in the man's semen.
• Where to Get It: Talk to your health care provider; cost can be fairly expensive depending on where you have the procedure done and how much your insurance will cover.

Withdrawal (coitus interruptus)

• Concept: The man withdraws his penis from the vagina before ejaculation.
• Success Rate: With typical use, nineteen women out of 100 become pregnant in one year. With perfect use, four women out of 100 become pregnant in one year.
• Positives: It's better than not using any protection, but it isn't a very effective method of birth control.
• Negatives: Because live sperm can live in pre-ejaculate, even if a man withdraws right some semen can escape prior to ejaculation, so you have a good chance of getting pregnant. It does not protect against STDs, including HIV. Also, it may be a stressful method to rely on because women have to rely on a man to get it right, and men have to concentrate on pulling out so they may not be able to enjoy the moment.
• Where to Get It: Just do it.

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Emergency Contraception

Had intercourse without birth control (or a condom break) in the past three days? Call your health care provider or a clinic to ask about your emergency contraception options, or call the Emergency Contraception Hotline at 1-888-NOT2LATE to find a clinic near you.

Afraid you might be pregnant? See your health care provider for a pregnancy test as soon as you can, or get a pregnancy test at the drugstore. If you use a home test, make sure you follow the package directions. You may not be able to get an accurate test result soon after having unprotected sex. If the test is negative, take another one again in a week. If it's positive, definitely see your health care provider right away. An exam to confirm pregnancy early can help avoid possible problems later on. To find a health care provider near you where you can get confidential testing and information, call the Planned Parenthood Hotline at 1-800-230-PLAN.

next: What Teens Want Other Teens To Know About Preventing Teen Pregnancy

The overall incidence of eating disorders among teenage girls is low, but those who develop them are at high risk for other emotional problems that linger into early adulthood.

That is the conclusion of a new study by the Oregon Research Institute in Eugene and published in the Journal of the American Academy of Adolescent Psychiatry. It finds a much higher percentage of those with symptoms of bulimia, symptoms of anorexia, and partial versions of those diseases also suffer with more depression, anxiety disorders, and substance abuse problems than the general teen population.

"The whole study is based on a large cohort of high school students we recruited in the 1980s, and we've been following them ever since," says study author Peter M. Lewinsohn, PhD, senior research scientist and professor emeritus in psychology at the University of Oregon in Eugene.

For this study, the students were examined twice during adolescence and once in their 24th year. Lewinsohn says that the number of males with eating disorders in this study was so small that the researchers only looked at the problem in girls.

The study found that kids with eating disorders were twice as likely to have a psychological problem as a group of "no-eating-disorder" kids -- and that rate was approaching 90%. And among the kids with eating disorders, more than 70% of them continued to have psychological problems at age 24.

"I think an eating disorder needs to be understood in the context of a lot of other problems," Lewinsohn says. "It doesn't seem it occurs by itself. We would like to have looked at "pure" eating disorder people, but there weren't enough of them."

Lewinsohn suggests adolescent girls be routinely screened for eating disorders during physical examination -- especially if they are known to have a psychological disorder. Conversely, those kids with known eating disorders ought to be cross-checked for psychological problems, he says. "I think the pediatricians are the gatekeepers here, because they see everybody. They are in a very important position to identify these problems."

One eating disorders expert says it's hard to say whether all eating disorder patients have mental problems, as well. "I know with bulimia, many of the girls, if they develop it later, they view it as 'trying it' because their friends are doing it -- and are less likely to be psychologically impaired," says Elizabeth Carll, PhD, who has a private practice in Long Island, N.Y. "The earlier ones have a poorer prognosis."

As for screening teenage girls for eating disorders: "I think it's great," Carll says. "But most girls will not admit it. With anorexia, it's pretty obvious. But with bulimia, many of the girls are quite secretive. They may admit to being concerned with dieting -- which might be a risk factor if they're at a normal weight."

But "might" is the operative word there. Carll points out that about 75% of American women, if asked at any given time, would say they are on a diet -- when only about a third really need to be. "It's a condition both cultural and sociological," she says. "It's an obsession with thinness, and in our culture, an obsession with health and nutrition."

"It's different for every patient, but we know eating disorders have very little to do with food and eating," says Mae Sokol, MD, a child and adolescent psychiatrist with the Eating Disorders Program at the Menninger Clinic in Topeka, Kan. "It's not a coincidence that these things begin in adolescence when there's a search for identity."

She recommends pediatricians learn to ask the right questions to ferret out a possible eating disorder. If, for example, a teen shows up with an athletic injury, it would offer an opportunity to check for out-of-control exercising. Complaints of an upset stomach might reveal forced vomiting. Sokol suggests it's probably easier in the long run to catch an eating disorder during adolescence: "It is true that once they get to their 18th birthday they have more say over their fate. I'm a believer in involuntary treatment if that's all you can do. But it's easier when they're a child and their parents have a say."

As for that involuntary treatment, Sokol says she sometimes recommends parents of older teenagers (those considered by law to be adults) to ask a judge for medical guardianship -- which reduces the older teens to children in the eyes of the state.

"This behavior in severe form is very similar to suicide," she says. But with proper treatment -- including psychotherapy and nutritional monitoring -- there is hope. "I'm a firm believer there is life after an eating disorder. Some do get completely cured," she says. "Treatment is really important. It can make the difference between a chronic case and one that is cured."

next: The Five Greatest Motivators For Preschool Children to Eat Healthy Foods
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Suggestions to keep the Alzheimer's patient from wandering away.

The biggest fear that most caregivers have is how to prevent their loved one from leaving the house, unsupervised, and wandering away.

• Place locks on exit doors high or low on the door out of direct sight. Consider double locks that require a key. Keep a key for yourself and hide one near the door for emergency exit purposes.
• Use loosely fitting doorknob covers so that the cover turns instead of the actual knob. Due to the potential hazard they could cause if an emergency exit is needed, locked doors and doorknob covers should be used only when a caregiver is present.
• Install safety devices found in hardware stores to limit the distance that windows can be opened.
• If possible, secure the yard with fencing and a locked gate. Use door alarms such as loose bells above the door or devices that ring when the doorknob is touched or the door is opened. 
• Avoid medicating the person to prevent them from walking away. Doses that are sufficiently powerful to stop someone from 'wandering' can cause drowsiness, increase confusion and possibly cause incontinence.
• Some caregivers have found that placing a mirror in the hall, or fixing a bead curtain across the front door, can deter the person from leaving. However, this approach may be confusing or distressing for the person with Alzheimer's.
• Whenever possible, the patient should sleep on the lower level. Nighttime presents a variety of risks.

Limiting the Risks of Wandering Away with Alzheimer's

• Do not leave a person with Alzheimer's disease who has a history of wandering unattended.
• If the person is determined to leave, try not to confront them as this could be upsetting. Try to accompany them a little way and then divert their attention so that you both return.
• Make sure the person carries some form of identification or the name and phone number of someone who can be contacted if they get lost. You could sew this into a jacket or a handbag so that it is not easily removed. Obtain a medical identification bracelet for the person with AD with the words "memory loss" inscribed along with an emergency telephone number. Place the bracelet on the person's dominant hand to limit the possibility of removal, or solder the bracelet closed. Check with the local Alzheimer's Association about the Safe Return program.
• Tell local shopkeepers and neighbors about the person's Alzheimer's - they may offer to keep a look out.
• If the person is in day care, respite residential care or long term care, tell the staff about their walking habits and ask about the policy of the home.
• If the person does disappear, try not to panic.
• If you are unable to find them, tell the local police. Keep a recent photograph, to help the police identify them.
• When the person returns, try not to scold them or show them that you are worried. If they got lost, they may be feeling anxious themselves. Reassure them, and quickly get them back into a familiar routine.
• Once the situation is resolved, try to relax. Phone a family member or friend and talk about your feelings. Remember that this type of behavior is likely to be a phase.

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Safe Return Program

The Alzheimer's Association's Safe Return program is designed to help identify people who wander and return them to their caregiver. Caregivers who pay a $40 registration fee receive:

• An identification bracelet
• Name labels for clothing
• Identification cards for wallet or purse
• Registration in a national database with emergency contact information
• A 24-hour toll-free number to report someone who is lost

You can register someone by filling out a form online at the Alzheimer's Association's Web page or by calling (888) 572-8566.

Sources:

• National Institute on Aging, Home Safety for People with Alzheimer's Disease, Oct. 2007
• Wisconsin Bureau of Aging and Long Term Care Resources, Department of Health and Family Services, How to Succeed: Caregiving Strategies That Provide Answers for Common Behavior Themes, July 2003.

next: Helping Someone With Alzheimer's

Covers SAMe, a natural treatment of depression, Alzheimer's Disease, and fibromyalgia. Learn about the usage, dosage, side-effects of SAMe.

• Overview
• Uses
• Dietary Sources
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

S-Adenosylmethionine (SAMe) is a naturally occurring compound that is involved in many biochemical processes in the body. SAMe plays a role in the immune system, maintains cell membranes, and helps produce and break down brain chemicals such as serotonin, melatonin, and dopamine as well as vitamin B12. SAMe also participates in the making of genetic material, known as DNA, and cartilage. Low amounts of folate (vitamin B9) in the body may lead to reduced levels of SAMe.

Numerous scientific studies indicate that SAMe may be useful in the treatment of depression, osteoarthritis, fibromyalgia, and liver disorders. Although it has been available in Europe by prescription for a number of years, SAMe was only recently introduced as a dietary supplement in the United States.

 

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SAM-e Uses

SAMe offers a variety of potential therapeutic uses, primarily in the treatment of the health conditions listed below. It is important to note that SAMe has not been tested carefully over long periods of time. For this reason, it is not yet known whether using SAMe for an extended length of time (months or years) is safe.

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SAM-e for depression
Preliminary research suggests that SAMe is more effective than placebo in treating mild to moderate depression and is just as effective as anti-depressant medications without the side affects frequently associated with the medications (headaches, sleeplessness and sexual dysfunction). Plus, antidepressants tend to take six to eight weeks to begin working, while SAMe seems to begin much more quickly than that.

More research regarding the safety and effectiveness of SAMe, especially for longer periods of time, is needed. It is not clear exactly how SAMe works to relieve depression, so it is best to avoid using SAMe together with other antidepressants. In addition, given the serious nature of this mood disorder, professional help should be sought for symptoms of depression before taking SAMe or any substance.

Osteoarthritis
Laboratory and animal studies suggest that SAMe may reduce pain and inflammation in the joints as well as promote cartilage repair, but researchers are not clear about how or why this works. Clinical trials with people (although generally small in size and of short duration) have also shown favorable results for SAMe when used to relieve osteoarthritis symptoms. In several short-term studies (ranging from 4 to 12 weeks), SAMe supplements were as effective as NSAIDs (nonsteroidal anti-inflammatory drugs) in adults with knee, hip, or spine osteoarthritis. SAMe was equivalent to the medications in diminishing morning stiffness, decreasing pain, reducing swelling, improving range of motion, and increasing walking pace. Several of the studies also suggest that SAMe has fewer side effects than NSAIDs.

Fibromyalgia
From studies comparing SAMe to placebo, this supplement seems to improve pain, fatigue, morning stiffness, and mood in those with fibromyalgia.

Liver Disease
Results of several animal studies suggest that SAMe may be beneficial in treating various liver disorders, particularly liver damage caused by excessive alcohol consumption. Animal studies also suggest that SAMe may protect the liver from damage after acetaminophen overdose (a pain-relieving medication purchased without a prescription). A study of 123 men and women with alcoholic liver cirrhosis (liver failure) found that SAMe treatment for 2 years may improve survival rates and delay the need for liver transplants more effectively than placebo. Although the results of this study are encouraging, more clinical trials are needed to determine whether SAMe is safe and effective for the prevention and/or treatment of liver disease.

SAM-e for Alzheimer's Disease
Studies suggest that people with Alzheimer's Disease (AD) have low levels of SAMe in the brain and that supplementation can actually increase those levels. While it has been reported that some individuals with AD have improved cognitive function from SAMe supplementation, well-designed research studies are needed to determine whether this supplement is truly safe and effective for people with the disease.

Other
Although it is premature to tell if these are safe or appropriate uses for SAMe, some early research has looked at the relationship between SAMe and Parkinson's disease, migraine headaches, Sjogrens disorder (which causes pain in connective tissue), attention deficit/hyperactivity disorder (ADHD) in adults, and vascular disorders such as heart disease.

SAMe levels may be low in people with Parkinson's and heart disease. However, experiments in rats have indicated that SAMe supplements may actually cause Parkinson's disease in these animals.

Given SAMe's structure, some have raised concern about the potential for SAMe to increase homocysteine levels. (Homocysteine has been shown to contribute to the development of plaques in the blood vessels). However, early information suggests that SAMe may actually lower homocysteine. Research is needed to know whether taking SAMe supplements may reduce homocysteine and reduce one's chances of getting heart disease.

A preliminary study of 124 migraine sufferers suggests that SAMe may decrease the frequency, intensity, and duration of headaches as well as lead to an improved sense of well being and use of fewer pain killers.

 

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Dietary Sources for SAM-e

SAMe is not found in food. It is produced by the body from ATP and the amino acid methionine. (ATP serves as the cell's major energy source and drives a number of biological processes including muscle contraction and the production of protein).

 

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Available Forms of SAM-e

• S-adenosylmethionine butanedisulfonate
• S-adenosylmethionine disulfate ditosylate
• S-adenosylmethionine disulfate tosylate
• S-adenosylmethionine tosylate

It is important to purchase enteric-coated tablets packaged in foil or foil blister packs. SAMe should be stored in a cool, dry place, but not refrigerated. Tablets should be kept in the blister pack until the time of ingestion.

 

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How to Take SAM-e

Starting with a low dose (for example 200 mg per day) and increasing slowly helps avoid upset to the digestive system.

It is important to note that many of the studies evaluating SAMe for the conditions mentioned have tested injectable, not oral, forms of SAMe. Therefore, the reliability and effectiveness of oral SAMe is not entirely clear. Look for enteric-coated tablets as these are more stable and may be more dependable in terms of the amount of SAMe in the pill.

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Pediatric

There are no known scientific reports on the pediatric use of SAMe. Therefore, it is not currently recommended for children.

Adult

Recommended doses of SAMe vary depending on the health condition being treated. The following list provides guidelines for the most common uses:

• depression: The majority of studies have used between 800 and 1,600 mg of SAMe per day for depression. The daily dosage is typically split between morning and afternoon.
• Osteoarthritis: A dosage of 600 mg (200 mg three times per day) for the first two weeks and then 400 mg (200 mg twice per day) for another 22 weeks has shown improvement in symptoms of osteoarthritis. Another study demonstrated improvement using 1,200 mg (400 mg three times per day) for 30 days.
• Fibromyalgia: A dosage of 800 mg per day for six weeks was shown to improve symptoms.
• Alcoholic liver disease: 800-1,200 mg per day orally in divided doses for six months enhances liver function. For liver disease, SAMe should be administered with the supervision of a qualified health care provider. This is because SAMe is administered intravenously.

 

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Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

The safety of SAMe has not been fully assessed in children or women who are pregnant or nursing. For this reason, these groups of people should avoid SAMe. Side effects may include dry mouth, nausea, flatulence, diarrhea, headache, anxiety, a feeling of elation, restlessness, and insomnia. For this reason, SAMe should not be taken at night.

People with bipolar disorder (manic-depression) should not take SAMe since it may worsen manic episodes. SAMe should not be combined with different antidepressants without first consulting a health care provider.

People taking SAMe should supplement its use with a multivitamin that contains folic acid and vitamins B12 and B6.

 

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Possible Interactions

If you are currently being treated with any of the following medications, you should not use SAMe without first talking to your healthcare provider.

SAM-e and antidepressant medications
There have been reports of SAMe interacting with antidepressant medications and increasing the potential for side effects including headache, irregular or accelerated heart rate, anxiety, and restlessness. On the other hand, because it often takes up to six or eight weeks for antidepressant medications to start working, SAMe has been used with certain drugs to relieve symptoms more quickly. Consult your healthcare provider before using SAMe if you are taking any medications for depression.

 

Supporting Research

Abittan CS, Lieber CS. Alcoholic liver disease. Curr Treat Options Gastroenterol. 1999;2(1):72-80.

Anonymous. SAMe for depression. Med Lett Drugs Ther. 1999;41(1065):107-108.

Baldessarini RJ. Neuropharmacology of S-adenosyl-L-methionine. Am J Med. 1987;83(5A):95-103.

Bell KM, et al. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand Suppl. 1994;154:15-8.

Berlanga C, Ortega-Soto HA, Ontiveros M, Senties H. Efficacy of S-adeno-L-methionine in speeding the onset of action of imipramine. Psychiatry Res. 1992;44(3):257-262.

Bottiglieri T. Folate, vitamin B12, and neuropsychiatric disorders. Nutr Rev. 1996;54(12):382-390.

Bottiglieri T, Godfrey P, Flynn T, Carney MWP, Toone BK, Reynolds EH. Cerebrospinal fluid S-adenosylmethionine in depression and dementia: effects of treatment with parental and oral -adenosylmethione. J Neurol Neurosurg Psychiatry. 1990;53:1096-1098.

Bottiglieri T, Hyland K, Reynolds EH. The clinical potential of ademetionine (S-adenosylmethionine) in neurological disorders. Drugs. 1994;48(2):137-152.

Bradley JD, Flusser D, Katz BP, Schumacher HR, Jr., Brandt KD, Chambers MA, et al. A randomized, double blind, placebo controlled trial of intravenous loading with S-adenosylmethionine (SAM) followed by oral SAM therapy in patients with knee osteoarthritis. J Rheumatol. 1994;21(5):905-911.

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Bray GP, Tredger JM, Williams R. S-adenosylmethionine protects against acetaminophen hepatotoxicity in two mouse models. Hepatotol. 1992;15(2):297-301.

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Carney MW, et al. The switch mechanism and the bipolar/unipolar dichotomy. Br J Psychiatry. 1989;154:48-51.

Carney MW, Toone BK, Reynolds EH. S-adenosylmethionine and affective disorder. Am J Med. 1987;83(5A):104-106.

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Cohen BM, et al. S-adenosyl-L-methionine in the treatment of Alzheimer's Disease. J Clin Psychopharmacol. 1988;8:43-47.

ConsumerLab.com. Product review: SAMe. 2000. Accessed at http://www.consumerlabs.com/results/same.asp on March 20, 2002.

Cooney CA, Wise CK, Poirer LA, Ali SF Methylamphetamine treatment affects blood and liver S-adenosylmethionine (Sam) in mice. Correlation with dopamine depletion in the striatum. Ann N Y Acad Sci. 1998;844:191-200.

di Pavoda C. S-adenosylmethionine in the treatment of osteoarthritis. Review of clinical studies. Am J Med. 1987;83(suppl 5A):60-65.

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Fetrow CW, Avila JR. Efficacy of the dietary supplement S-adenosyl-L-methionine. Ann Pharmacother. 2001;35(11):1414-1425.

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Comprehensive information on potassium mineral supplements. Learn about the usage, dosage, side-effects of potassium.

• Overview
• Uses
• Dietary Sources
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Potassium is a mineral that helps the kidneys function normally. It also plays a key role in cardiac, skeletal, and smooth muscle contraction, making it an important nutrient for normal heart, digestive, and muscular function. A diet high in potassium from fruits, vegetables, and legumes is generally recommended for optimum heart health.

Having too much potassium in the blood is called hyperkalemia and having too little in the blood is known as hypokalemia. Proper balance of potassium in the body depends on sodium. Therefore, excessive use of sodium may deplete the body's stores of potassium. Other conditions that can cause potassium deficiency include diarrhea, vomiting, excessive sweating, malnutrition, and use of diuretics. In addition, coffee and alcohol can increase the amount of potassium excreted in the urine. Adequate amounts of magnesium are also needed to maintain normal levels of potassium.

For most people, a healthy diet rich in vegetables and fruits provides all of the potassium needed. The elderly are at high risk for developing hyperkalemia due to decreased kidney function that often occurs as one ages. Older people should be careful when taking medication that may further affect potassium levels in the body, such as nonsteroidal anti-inflammatories (NSAIDs) and ACE inhibitors (see section on Interactions for additional information). Taking potassium supplements, at any age, should only be done under the guidance of a healthcare provider.

 

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Uses

Hypokalemia
The most important use of potassium is to treat the symptoms of hypokalemia, which include weakness, lack of energy, muscle cramps, stomach disturbances, an irregular heartbeat, and an abnormal EKG (electrocardiogram, a test that measures heart function). Treatment of this condition takes place under the guidance and direction of a physician.

Osteoporosis
High dietary intake of potassium from fruits and vegetables throughout one's life helps to preserve bone mass thereby preventing bone loss that can lead to osteoporosis.

High Blood Pressure
Some studies have linked low dietary potassium intake with high blood pressure. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends adequate amounts of potassium in the diet, along with other measures such as dietary calcium and weight loss, to prevent the development of high blood pressure. Similarly, the Dietary Approaches to Stop Hypertension (DASH) diet emphasizes eating foods rich in fruits, vegetables, and low- or non-fat dairy products to provide high intake of potassium, as well as magnesium and calcium.

While appropriate and adequate dietary intake is necessary for preventing or improving blood pressure, potassium supplements are probably not. Some animal and early human studies did suggest that potassium supplements could help to lower blood pressure. More recent well-designed studies, however, suggest that potassium supplements do not improve blood pressure significantly. Use of potassium supplements for blood pressure, therefore, depends on the medications you are taking and the instructions of your doctor.

Stroke
In several population based studies evaluating very large groups of men and women over time, a diet rich in potassium was associated with a reduced risk of stroke. For the men, this seems to be particularly true among those with high blood pressure and/or those taking diuretics (blood pressure medications that help the kidneys eliminate sodium and water from the body). Potassium supplements, however, do not seem reduce the risk of stroke.

Inflammatory Bowel Disease (IBD)
Amongst other nutrient deficiencies, people with IBD (namely, ulcerative colitis or Crohn's disease) often have low levels of potassium. Your doctor will determine if supplementation with potassium is necessary.

Asthma
Several studies have suggested that diets low in potassium are associated with poor lung function and even asthma in children compared to those who eat normal amounts of potassium. Enhancing dietary intake of potassium through foods such as fish, fruits, and vegetables may, therefore, prove to be of value for preventing or treating asthma.

 

 

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Dietary Sources for Potassium

The best dietary sources of potassium are fresh unprocessed foods, including meats, fish, vegetables (especially potatoes), fruits (especially avocados, dried apricots, and bananas), citrus juices (such as orange juice), dairy products, and whole grains. Most potassium needs can be met by eating a varied diet with adequate intake of milk, meats, cereals, vegetables, and fruits.

 

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Available Forms of Potassium

There are several potassium supplements on the market, including potassium acetate, potassium bicarbonate, potassium citrate, potassium chloride, and potassium gluconate.

Potassium can also be found in multivitamins.

 

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How to Take Potassium

Potassium supplements, other than the small amount included in a multivitamin, should only be taken under the specific guidance and instruction of a healthcare provider. This is particularly true for children.

The recommended daily intakes of dietary potassium are listed below:

Pediatric

• Infants birth to 6 months: 500 mg or 13 mEq
• Infants 7 months to 12 months: 700 mg or 18 mEq
• Children 1 year: 1000 mg or 26 mEq
• Children 2 to 5 years: 1400 mg or 36 mEq
• Children 6 to 9 years: 1600 mg or 41 mEq
• Children over 10 years: 2000 mg or 51 mEq

Adult

• 2000 mg or 51 Meq, including for pregnant and nursing women.

 

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Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider. In the case of potassium, this is particularly important in the elderly.

Diarrhea and nausea are two common side effects from potassium supplements. Other potential adverse effects include muscle weakness, slowed heart rate, and abnormal heart rhythm.

Excessive amounts of the herb licorice (not licorice candy) and caffeine-containing herbs (such as cola nut, guarana, and possible green and black tea) can lead to loss of potassium.

Potassium must not be used by people with hyperkalemia.

 

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Possible Interactions

If you are currently being treated with any of the following medications, you should not use potassium without first talking to your healthcare provider.

Potassium levels may be increased by the following medications:

• Nonsteroidal anti-inflammatory drugs (NSAIDs; such as ibuprofen, piroxicam, and sulindac): This interaction is particularly likely to occur in people with decreased kidney function.
• ACE inhibitors (such as captopril, enalapril, and lisinopril): This interaction is particularly likely to occur in people who are taking NSAIDs, potassium-sparing diuretics (such as spironolactone, triamterene, or amiloride), or salt substitutes along with the ACE inhibitor. A rise in potassium from ACE inhibitors may also be more likely in people with decreased kidney function and diabetes.
• Heparin (used for blood clots)
• Cyclosporine (used following a transplant to suppress the immune system)
• Trimethoprim (an antibiotic)
• Beta-blockers (such as metoprolol and propranolol that are used to treat high blood pressure)

Potassium levels may be decreased by the following medications:

• Thiazide diuretics (such as hydrochlorothiazide)
• Loop diuretics (such as furosemide and bumetanide)
• Corticosteroids
• Amphotericin B
• Antacids
• Insulin
• Theophylline (used for asthma)
• Laxatives

Please refer to the depletions monographs related to these medications for additional information. A healthcare practitioner will determine whether potassium supplements are needed when individuals are taking these medications.

Other potential interactions include:

• Digoxin: Low blood levels of potassium increase the likelihood of toxic effects from digoxin, a medication used to treat abnormal heart rhythms. Normal levels of potassium should be maintained during digoxin treatment which will be measured and directed by the healthcare provider.

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Supporting Research

Alappan R, Perazella MA, Buller GK, et al. Hyperkalemia in hospitalized patients treated with trimethoprim-sulfamethoxazole. Ann Intern Med. 1996;124(3):316-320.

Appel LJ. Nonpharmacologic therapies that reduce blood pressure: a fresh perspective. Clin Cardiol. 1999;22(Suppl. III):III1-III5.

Apstein C. Glucose-Insulin-Potassium for acute myocardial infraction: remarkable results from a new prospective, randomized trial. Circ. 1998;98:2223 - 2226.

Apstein CS, Opie Lh. Glucose-insulin-potassium (GIK) for acute myocardial infarction: a negative study with a positive value. Cardiovasc Drugs Ther. 1999;13(3):185-189.

Ascherio A, Rimm EB, Hernan MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among U.S. men. Circ. 1998;98:1198 - 1204.

Brancati FL, Appel LJ, Seidler AJ, Whelton PK. Effect of potassium supplementation on blood pressure in African Americans on a low-potassium diet. Arch Intern Med. 1996;156:61 - 72.

Brater DC. Effects of nonsteroidal anti-inflammatory drugs on renal function: focus on cyclooxygenase-2-selective inhibition. Am J Med. 1999;107(6A):65S-70S.

Burgess E, Lewanczuk R, Bolli P, et al. Lifestyle modifications to prevent and control hypertension. 6. Recommendations on potassium, magnesium and calcium. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ. 1999;160(9 Suppl):S35-S45.

Cappuccio EP, MacGregor GA. Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens. 1991;9:465-473.

Chiu TF, Bullard MJ, Chen JC, Liaw SJ, Ng CJ. Rapid life-threatening hyperkalemia after addition of amiloride HCL/hydrochlorothiazide to angiotensin-converting enzyme inhibitor therapy. Ann Emerg Med. 1997;30(5):612-615.

Gilliland FD, Berhane KT, Li YF, Kim DH, Margolis HG. Dietary magnesium, potassium, sodium, and children's lung funtion. Am J Epidemiol. 2002. 15;155(2):125-131.

Hermansen K. Diet, blood pressure and hypertension. Br J Nutr. 2000:83(Suppl 1):S113-119.

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Heyka R. Lifestyle management and prevention of hypertension. In: Rippe J, ed. Lifestyle Medicine. 1st ed. Malden, Mass: Blackwell Science; 1999:109-119.

Hijazi N, Abalkhail B, Seaton A. Diet and childhood asthma in a society in transition: a study in urban and rural Saudi Arabia. Thorax. 2000;55:775-779.

Howes LG. Which drugs affect potassium? Drug Saf. 1995;12(4):240-244.

Iso H, Stampfer MJ, Manson JE, et al. Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women. Stroke. 1999;30(9):1772-1779.

Joint National Committee. Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Arch Int Med. 1997;157:2413-2446.

Kendler BS. Recent nutritional approaches to the prevention and therapy of cardiovascular disease. Prog Cardiovasc Nurs. 1997;12(3):3-23.

Krauss RM, Eckel RH, Howard B, et al. AHA dietary guidelines. Revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000;102:2284-2299.

Matsumura M, Nakashima A, Tofuku Y. Electrolyte disorders following massive insulin overdose in a patient with type 2 diabetes. Intern Med. 2000;39(1):55-57.

Newnham DM. Asthma medications and their potential adverse effects in the elderly: recommendations for prescribing. Drug Saf. 2001;24(14):1065-1080.

Olukoga A, Donaldson D. Liquorice and its health implications. J Royal Soc Health. 2000;120(2):83-89.

Pasic S, Flannagan L, Cant AJ. Liposomal amphotericin is safe in bone marrow transplantation for primary immunodeficiency. Bone Marrow Transplant. 1997;19(12):1229-1232.

Perazella MA. Trimethoprim-induced hyperkalemia: clinical data, mechanism, prevention and management. Drug Saf. 2000;22(3):227-236.

Perazella M, Mahnensmith R. Hyperkalemia in the elderly. J Gen Intern Med. 1997;12:646 - 656.

Physicians' Desk Reference. 55th ed. Montvale, NJ: Medical Economics Co., Inc.; 2001:1418-1422, 2199-2207.

Poirier TI. Reversible renal failure associated with ibuprofen: case report and review of the literature. Drug Intel Clin Pharm. 1984;18(1):27-32.

Preston RA, Hirsh MJ MD, Oster, JR MD, et al. University of Miami Division of Clinical Pharmacology therapeutic rounds: drug-induced hyperkalemia. Am J Ther. 1998; 5(2):125-132.

Ray K, Dorman S, Watson R. Severe hyperkalemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction. J Hum Hypertens. 1999;13(10):717-720.

Reif S, Klein I, Lubin F, Farbstein M, Hallak A, Gilat T. Pre-illness dietary factors in inflammatory bowel disease. Gut. 1997;40:754-760.

Sacks FM, Willett WC, Smith A, et al. Effect on blood pressure of potassium, calcium, and magnesium in women with low habitual intake. Hypertens. 1998;31(1):131 - 138.

Shionoiri H. Pharmacokinetic drug interactions with ACE inhibitors. Clin Pharmacokinet. 1993;25(1):20-58.

Singh RB, Singh NK, Niaz MA, Sharma JP. Effect of treatment with magnesium and potassium on mortality and reinfarction rate of patients with suspected acute myocardial infarction. Int J Clin Pharmacol Thera. 1996;34:219 - 225.

Stanbury RM, Graham EM. Systemic corticosteroid therapy - side effects and their management. Br J Ophthalmol. 1998;82(6):704-708.

Suter PM. Potassium and Hypertension. Nutrition Reviews. 1998;56:151 - 133.

Tucker KL, Hannan Mt, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr. 1999;69(4):727-736.

Whang R, Oei TO, Watanabe A. Frequency of hypomagnesia in hospitalized patients receiving digitalis. Arch Intern Med. 1985;145(4):655-656.

Whelton, A, Stout RL, Spilman PS, Klassen DK. Renal effects of ibuprofen, piroxicam, and sulindac in patients with asymptomatic renal failure. A prospective, randomized, crossover comparison. Ann Intern Med. 1990;112(8):568-576.

Young DB, Lin H, McCabe RD. Potassium's cardiovascular protective mechanisms. Am J Physiology. 1995;268(part 2):R825 - R837.

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Discover what causes premature ejaculation and techniques to treat premature ejaculation. Along with comments on having an orgasm.

Rarely a physiological problem, premature ejaculation can result from over-excitement, positioning or rate of intercourse. "The roots of it go back to the way men learn to orgasm, which is typically through masturbation," suggests Kaminetsky. "A lot of young boys masturbate quickly, because they don't want their mom to walk in on them. It becomes a trained behavior." To treat premature ejaculation, experts suggest changing positions, breathing deeply, thinking about something other than sex or simply stopping for a moment. Here, Kaminetsky offers two additional techniques for delaying orgasm:

• Practice this before reaching "ejaculatory inevitability," the point when ejaculation cannot be stopped; most men recognize it as a sensation of deep warmth or pleasure: Squeeze the head of the penis for about four seconds or until the sensation subsides, then resume.
• During intercourse, the man should press his pelvic bone against the woman's and rock rather than thrust his body. "It won't be as stimulating for him so he'll last longer, and it may be more stimulating for the woman."

HIS BENEFITS

• Long life: Men who have two or more orgasms a week tend to live significantly longer than do those who have only one or none, according to research at Cardiff University in Wales.
• Less cancer: Breast cancer is rare in men, but once developed, the mortality rate is high. Fortunately, a study published in the British Journal of Cancer found that men who have more than six orgasms a month are significantly less likely to develop breast cancer than are those who have less frequent sex.
• Healthy hearts: A study of 2,500 men at the University of Bristol and Queens University of Belfast found that men who have at least three or more orgasms a week are 50 percent less likely to die from heart failure or coronary heart disease.
• Good health: Having sex once or twice a week also fights off the flu and other viruses by strengthening the immune system, psychologists at the University of Pennsylvania recently found.
• Youthful looks: A study of 3,500 aging people at the Royal Edinburgh Hospital in Scotland found that those who looked the youngest also had the most vigorous sex life. The effects were even greater if the subjects were emotionally satisfied as well.

READ MORE ABOUT IT: The Good Girl's Guide to Bad Girl Sex Barbara Keesling, Ph.D. (M. Evan and Co., 2001)

Sexual Fitness: 7 Essential Elements of Optimizing Your Sensuality, Satisfaction and Well-Being Hank C.K. Wuh, M.D. (G.P. Putnam's Sons, 2001)

Personal Comments

Bee, 25, Copywriter

Masturbating is the easiest way for women to learn how to have an orgasm. Women who masturbate will be a lot more likely to have an orgasm during sex. I think it helps you learn the actual mechanics of what turns you on, where things need to happen.

Because the guy isn't going to know that; there's no reason he would. Every woman is different. Also, the bonding that goes on during sex seems most extreme with an orgasm. It's kind of like one or both people have gone completely over the edge; they're suspended in the other person's grasp, and they're completely surrendered to it. That intensifies any connection.

Gabriel, 25, Musician

There are guys who don't get a rise out of giving a woman an orgasm and would just prefer not to have someone else there. I've even heard some guys say they have better orgasms during masturbation than sex. The mere thought of it astounds me, but it makes sense if a guy has a fear of intimacy or, even more, a fear of performing (performance anxiety). It probably takes away from his own orgasm if he's overly concerned with his sexual performance or whether or not she's having one. It's ironic because an orgasm during sex is enhanced when it's with someone you truly care about.

Kamara, 27, Musician

I'm amazed when I talk to anyone who claims to have never had an orgasm, probably because I just can't imagine not having them or not being able to have them. At the same time, it doesn't surprise me: I was raised in a very conservative religious atmosphere that actually called masturbation "self-abuse," and all sexuality -- not to mention orgasms -- was beautiful and good only if it happened in a marriage bed. It takes a while to expel the load of guilt that piles up around your sexuality if you're raised in that kind of culture, and I'm sure some people never do. But there was no way I wasn't going to aim for the prize once I knew what it felt like. Maybe it depends on your sexual drive -- for me, the drive was strong enough that I could never feel guilty about an orgasm for long.

Steven, 28, Veterinarian

Some guys think sex has to include an orgasm. Orgasms are great, but there's so much more to sex. An orgasm is more of a physical experience; I guess there is an emotional aspect, but it's over in a second. I think anybody can give you an orgasm, but it's the person there after the orgasm that matters. But I think I'm the exception.

Does Orgasm Equal Sex

Our ever-changing definition of sex may hinge more on the climax than on the act itself; Psychologist L.M. Bogart, Ph.D., gave Kent State students a list of scenarios in which "Jim" and "Susie" engaged in vaginal, anal or oral intercourse and either did or did not achieve orgasm. Vaginal intercourse was considered sex 97 percent of the time, followed by anal intercourse (93 percent) and oral sex (44 percent). Researchers were surprised to find that orgasm occurrence dictated whether or not the activity was considered sex. Although the woman was more likely to label vaginal intercourse sex if neither partner climaxed, when it came to oral sex, the recipient was more likely to consider it sex than the partner performing the act, especially if the recipient achieved orgasm -- because the stimulator was unlikely to achieve orgasm. For anal sex, it was more likely to be called sex if Jim had the orgasm, but it was sex to Susie regardless of whether she achieved orgasm. In general, the lack of orgasm for women was less likely to affect her labeling the act sex. Although most sex therapists argue against using orgasm as an end-all definition of sex, Bogart's study indicates that orgasm is still an important gauge by which we measure sexual activity.

Source: Psychology Today