Remafedi confirmed a 30% suicide rate among gay and bisexual youth generic 500mg actoplus met with amex diabetes mellitus with neurological manifestations, and also found that young men with more "feminine gender role characteristics" and those who recognized their same-sex orientation at an early age and acted on those sexual feelings seem to face the highest risk of self-destructive behavior buy genuine actoplus met line diabetes type 2 home test. The mean age in this sample at the time of the suicide attempts was 15 1/2 years order actoplus met 500 mg on line blood glucose ketones. Ingestion of prescription and/or nonprescription drugs and self-laceration accounted for 80% of the attempts. Twenty-one percent of the suicide attempts resulted in medical or psychiatric hospitalization, but almost 3 out of 4 attempts did not receive any medical attention. One-third of the first attempts occurred in the same year that subjects identified their bisexuality or homosexuality, and most other attempts happened soon thereafter. Family problems were the most frequently cited reason for attempts. Eighty-five percent of the attempters reported illicit drug use and 22% had undergone chemical dependency treatment. The earlier a young person is aware of a gay or lesbian orientation, the greater the problems they may face and may be more likely at risk of suicidal feelings and behavior. Younger gay adolescents may be at the highest risk for dysfunction because of emotional and physical immaturity, unfulfilled developmental needs for identification with a peer group, lack of experience, and dependence on parents unwilling or unable to provide emotional support. Younger gay adolescents are also more likely to abuse substances, drop out of school, be in conflict with the law, undergo psychiatric hospitalization, run away from home, be involved in prostitution, and attempt suicide. Pollak found that nearly all gay and lesbian suicides occur between the ages of 16 and 21. The fear of AIDS adds to the anxiety gay youths experience. Our culture conceives sex anatomy as a dichotomy: humans come in two sexes, conceived of as so different as to be nearly different species. However, developmental embryology, as well as the existence of intersexuals, proves this to be a cultural construction. Anatomic sex differentiation occurs on a male/female continuum, and there are several dimensions. Genetic sex, or the organization of the "sex chromosomes," is commonly thought to be isomorphic to some idea of "true sex. Since genetic testing was instituted for women in the Olympic Games, a number of women have been disqualified as "not women," after winning. However, none of the disqualified women is a man; all have atypical karyotypes, and one gave birth to a healthy child after having been disqualified. The sex chromosomes determine the differentiation of the gonads into ovaries, testes, ovo-testes, or nonfunctioning streaks. The hormones produced by the fetal gonads determine the differentiation of the external genitalia into male, female, or intermediate (intersexual) morphology. Genitals develop from a common precursor, and therefore intermediate morphology is common, but the popular idea of "two sets" of genitals (male and female) is not possible. Intersexual genitals may look nearly female, with a large clitoris, or with some degree of posterior labial fusion. They may look nearly male, with a small penis, or with hypospadias. They may be truly "right in the middle," with a phallus that can be considered either a large clitoris or a small penis, with a structure that might be a split, empty scrotum, or outer labia, and with a small vagina that opens into the urethra rather than into the perineum. Androgen Insensitivity Syndrome, or AIS, is a genetic condition, inherited (except for occasional spontaneous mutations), occurring in approximately 1 in 20,000 individuals. In an individual with complete AIS and karyotype 46 XY, testes develop during gestation. The fetal testes produce mullerian inhibiting hormone (MIH) and testosterone. As in typical male fetuses, the MIH causes the fetal mullerian ducts to regress, so the fetus lacks uterus, fallopian tubes, and cervix plus upper part of vagina. However, because cells fail to respond to testosterone, the genitals differentiate in the female, rather than the male pattern, and Wolffian structures (epididymis, vas deferens, and seminal vessicles) are absent. The newborn AIS infant has genitals of normal female appearance, undescended or partially descended testes, and usually a short vagina with no cervix. At puberty, the estrogen produced by the testes produces breast growth, though it may be late. Most AIS women have no pubic or underarm hair, but some have sparse hair. When an AIS girl is diagnosed during infancy, physicians often perform surgery to remove her undescended testes. Although removal of testes is advisable, because of the risk of cancer, ISNA advocates that surgery be offered later, when the girl can choose for herself. Vaginoplasty surgery is frequently performed on AIS infants or girls to increase the size of the vagina, so that she can engage in penetrative intercourse with a partner with an average size penis. Vaginoplasty surgery is problematic, with many failures. Such surgery should be offered to, not imposed on, the pubertal girl, and she should have an opportunity to speak with adult AIS women about their sexual experience and about surgery in order to make a fully informed decision. Some women have successfully increased the depth of their vagina with a program of regular pressure dilation, using aids designed for that purpose. Physicians and parents have been most reluctant to be honest with AIS girls and women about their condition, and this secrecy and stigma has unnecessarily increased the emotional burden of being different. Because AIS is a genetic defect located on the X chromosome, it runs in families. Except for spontaneous mutations, the mother of an AIS individual is a carrier, and her XY children have a 1/2 chance of having AIS. Her XX children have a 1/2 chance of carrying the AIS gene. Most AIS women should be able to locate other AIS women among siblings or maternal relatives. The answer depends upon exactly what you are looking for--diagnostic information, or carrier status. If were born with female genitals and testes, and have very sparse or absent pubic hair, you most likely have complete AIS. If you were born with ambiguous genitals and testes, there are a number of possible etiologies, including partial AIS. Testing for partial AIS is more problematic than the complete form. Hormonal tests in a newborn with 46 XY karyotype and ambiguous genitals will show normal to elevated testosterone and LH, and a normal ratio of testosterone to DHT. A family history of ambiguous genitals in maternal relatives suggestspartial androgen insensitivity. If you are wondering if you are a carrier, or if you know that you are a carrier and are wondering about the status of your fetus, genetic testing is possible.
I grieved over the loss of my childhood and my life cheap 500mg actoplus met otc managing diabetes uk. Russell Friedman: Absolutely purchase actoplus met online pills diabetes type 2 reversal diet, Katy order actoplus met 500 mg online diabetic urine test, any other outcome would almost be illogical. David: We seem to have a lot of people in the audience, Russell, who have suffered very large multiple losses. Traumatic childhood, several deaths in my family in the last four years, and a lifetime of being depressed. Two years ago, I was hit by a car and suffered a fracture in my right ankle. I had surgery, etc -- all the stuff that goes with it. The second surgery was a year later to take out the pins. David: This sort of brings me to the question, do you think that with multiple losses, we leave ourselves open to self blame? When you acquire better skills you can replace the old, ineffective ones. I have difficulty accepting totally losing all my children to this. It points out just how essential it is that we learn better ways of dealing with loss. I, myself, have lost contact with a child who I was very close with because of a falling out with her mother. My heart is broken, but I must deal with it so that my life is not limited any further. As to the abuse issues, the tragedy is exponential: when anyone has been abused sexually, physically, emotionally, etc. Grief Recovery is very helpful in limiting the ongoing impact of things that happened a long time ago. David: "Acceptance" is one of the hardest parts of the grieving process. Russell Friedman: David, acceptance, from a grief recovery point of view, is different than other uses of that word. For us, acceptance is the result of the actions of completing what is emotionally unfinished. It is not uncommon for broken hearted people to feel that way. Therefore, it becomes important for you to learn better ways to deal with the feelings you have. That is how I look at it now -much differently than I did before my daughter died. MicroLion: Why does the pain of grief and depression seem to keep coming in "waves? In part, it is because our bodies have a kind of thermostat, so when we are emotionally overwhelmed it kind of shuts us down. On another front, the factor of how many reminders or stimuli to remember the person or relationship vary. Friedman, do the feelings/stages that are described by Kubler-Ross in " On Death and Dying " apply to the stages that we might go through with the loss of our loved one, our marriage if it fails, or a pet that dies? The stages she defined were about what you might go through if you were told you had a terminal illness. Therefore, although I have talked to more than 50,000 people who are dealing with loss, I have never met one who was in denial that a loss had occurred. The first thing they say to me is, "my mom died" or "my husband left me. Russell Friedman: del25, if you have been here for the whole chat, you might recall that a few times I alluded to "in a crisis we go back to old behavior. A second might be that the level of safety one feels about showing others the raw emotions you are feeling might cause you to avoid contact. And thirdly, you get to be YOU, and whatever you do is okay and normal, because it is you reacting to your own loss. This mother that lost her daughter has been running constantly and does not know how to slow down. This is fitting into your discussion about doing the real grief work. Russell Friedman: jmitchell, all loss is about relationships. From the moment a woman becomes pregnant she begins a relationship with the baby inside of her. When that relationship is altered by the death of the baby, it is devastating. The moms (and dads) must grieve and complete those relationships just as they would others of longer duration. For the first time in my life, I have lost someone special in a violent way. Does anyone ever really get past a death that was so violent and unexpected? Russell Friedman: ict4evr2, without wishing to seem simplistic or insensitive, let me suggest that length of time is not the essential issue, rather it is the actions taken within time that can lead to a diminution of the horrific pain caused by loss. Also, please recognize that the "violence" is only one aspect of the loss. A question we always ask, though it might sound crude, is: "Would you miss them any less had they died some other way? It is the fact that they died, not how, which is the key element of grief. I tend to close myself off to future relationships for fear of further loss which would cause too much pain. Russell Friedman: Pantera, again, it would almost be illogical for you to do anything else, at this point. If your heart is full of the pain from prior losses, it is almost a definition of being "emotionally unavailabe" or "not being able to make a commitment. Friedman, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. We have a very large and active community here at HealthyPlace. You will always find people interacting with various sites.
Themes of connectedness and separateness in these four interview passages were important dynamics in understanding the meaning of psychological intimacy to participants actoplus met 500mg on line diabetes definition symptoms treatment. The elements of proximity cheap actoplus met 500mg with mastercard pregnancy diabetes test values, closeness generic actoplus met 500mg on-line diabetes type 1 ketogenic diet, mutuality, and interdependence may have been shaped most significantly by the interaction of males and females in same- and opposite-gender relationships. That is, it may not be gender alone that accounts for the differences between males and females. If women value attachment in relationships in a way different from men, then the data may suggest a mutually reinforcing process toward strengthening connectedness in lesbian relationships. In heterosexual and gay male relationships, the value that males place on separateness in relationships may temper the quality of attachment that develops over the years, and therefore results in different forms of psychological intimacy. Psychological intimacy between lesbian partners had a different relational history from that of heterosexual and gay male partners. From the early years to recent years, our data suggest a progressive shift toward psychological intimacy between lesbian partners. Lesbians were as evasiveof face-to-face discussions of conflict as heterosexual and gay male males, during the early years of their relationships. For lesbians, the avoidance appeared to be a consequence of fearing abandonment by their partners if they openly confronted differences. Only as lesbian couples became increasingly disenchanted with their relationships did modification in conflict management styles occur. Usually, one partner took the risk of expressing her unhappiness. That encounter resulted in 85% of lesbians applying for couple therapy. Based on the reports of lesbian respondents about the meaning of therapy to their relationships, being involved in treatment may have supported the development of psychologically intimate communication between partners. Qualitative modes of data collection based on in-depth interviews conducted are an effective tool for studying elusive phenomena, such as psychological intimacy. The richness of data elicited through the method used in this study is quite different from data collected through other means, although there are concerns about validity and reliability, as well as the nature of the sample. Psychological intimacy between lesbian partners had a different relational history from that of heterosexual and gay male partners. From the early years to recent years, our data suggest a progressive shift toward psychological intimacy between lesbian partners. Lesbians were as evasive of face-to-face discussions of conflict as heterosexual and gay male males, during the early years of their relationships. For lesbians, the avoidance appeared to be a consequence of fearing abandonment by their partners if they openly confronted differences. Only as lesbian couples became increasingly disenchanted with their relationships did modification in conflict management styles occur. Usually, one partner took the risk of expressing her unhappiness. That encounter resulted in 85% of lesbians applying for couple therapy. Based on the reports of lesbian respondents about the meaning of therapy to their relationships, being involved in treatment may have supported the development of psychologically intimate communication between partners. It is difficult to assess the validity of the data in the traditional sense of that concept, since we were eliciting the personal perceptions and evaluations of participants about the meaning of psychological intimacy in their relationships at a particular point in time. The candor of participants on highly personal matters, such as the decline in sexual relations because of sexual dysfunctions, suggests that participants were equally candid about other aspects of their relationships, such as psychological intimacy. By interviewing partners separately and asking them to talk about themselves, as well as their observations of their partners in these relationships, we were able to compare responses to determine if there were significant differences over common realities. For example, did both partners assess the nature of conflict in their relationships similarly? Correspondenc e between partners was permitted in the study, which was illustrated in the responses to conflict management styles, when participants were asked to describe their style as well as the style of their partners. For example, partners who described themselves as having an evasive style were viewed by their partners in an equivalent way. In a cross-sectional design in which participants are asked to report on their life today and in the past, traditional measures of reliability are inadequate. While longitudinal designs may be superior in contending with problems of validity and reliability, cross-sectional designs that use interviews to uncover the meaning of behavior have the strength of eliciting the richness in the experiences of human beings. There is a shortfall in recoding the data from multiple categories into dichotomous ones. This step built onto the earlier qualitative analysis by offering a different lens through which to understand the data. To offset the potential reductionistic effects of recoding, we have incorporated a discussion of the qualitative data into the results. The integration of qualitative and quantitative procedures was intended to enhance the theory development objective of the research. The use of an interdisciplinary team throughout the research process enhanced the quality of the study. Issues of bias, misinterpretation, and other matters that could affect the validity and reliability of the data were discussed. One of the principal investigators read all 216 interview transcripts and served as a second blind coder for each interview. Having one researcher read and code every interview provided for continuity in the operational definitions of variables. To insure that there was both a male and a female perspective on the data, the second coder was a woman. The sample was selected purposively to include participants not often included in other studies in lasting relationships; namely, people of color, blue-collar participants, and same-gender couples. The goal was not to test theory but to develop an understanding of a subject--psychological intimacy among an older group of diverse partners in lasting relationships--that has not received much attention by researchers. The sample fit with the goal of this exploratory study. The study of psychological intimacy in human relationships is a highly complex and dynamic process. Defining intimacy is a challenge, as is the importance of specifying the operational parameters. Wedefined psychological intimacy as the sense that participants had of their relationships as a place in which they could share personal thoughts and feelings about themselves and their relationships not expressed customarily with others. In this definition, positive communication was a quintessential component of psychological intimacy. We focused on cognitive themes about the meaning of relationships to individual partners rather than on specific interpersonal behaviors.
Impotence (difficulty in getting or keeping an erection) can be a cause of depression in men purchase actoplus met visa diabetes treatment centers. Again order actoplus met with paypal diabetes symptoms bruising, this is a problem for which it is usually possible to find effective help actoplus met 500mg on-line diabetic zucchini bread. We have known for many years some mothers feel severely depressed after having a child. It is only recently we have realized more than 1 in 10 men also suffer depression during this time. And this particular event changes your life more than any other. Suddenly, you have to spend much more of your time looking after your partner, and the children. On an intimate level, new mothers tend to be less interested in sex for a number of months. Simple tiredness is the main problem, although men may take it personally and feel they are being rejected. Paternity leave is still quite unusual in the most parts of the world. Male depression will affect the mother and may have an important impact on how the baby grows and develops in the first few months. Research has shown up to 1 in 7 men will become depressed in the six months following unemployment. This rate of male depression is much more than would be expected in employed men. In fact, after relationship difficulties, unemployment is the most likely cause of depression in men. You may lose symbols of your success, such as the company car. You may have to adjust to looking after the home and children, while your wife or partner becomes the bread-winner. From a position of being in control, you may face a future over which you have little control, especially if it takes a long time to find another job. Of course, if men get depressed, they may well find it harder to get another job, which may make the depression worse. Retiring from paid employment may be a cause of depression in men, especially if their partner continues to work. It may take some time to get used to losing the structure of your day and contact with workmates. On the whole, gay men do not suffer from depression any more than straight men. However, it seems gay teenagers and young adults are more likely to become depressed, possibly due to the stresses associated with coming out. Depressed men are more than four times more likely to kill themselves than women. Suicide is most common amongst depressed men who are separated, widowed or divorced and is more likely if someone is a heavy drinker. We do know two-out-of-three people who kill themselves have seen their family doctor in the previous four weeks and nearly one-in-two will have done so in the week before they kill themselves. We also know about two-out-of-three people who kill themselves will have talked about it to friends or family. Asking if a depressed man is feeling suicidal will not put the idea into his head or make it more likely he will kill himself. So, although some men with depression may not be very good at talking about how they are feeling, it is important to ask if you have any suspicion - and to take such ideas seriously. For a depressed man who feels suicidal, there is nothing more demoralizing than to feel others do not take him seriously. Men with depression often have taken some time to pluck up the courage to tell anybody about it. If you do find yourself feeling so bad that you have thought about suicide, it can be a great relief to tell someone. Some studies have shown male depression is linked to violence. Many depressed men find it difficult to ask for help - it can feel unmanly and weak. Men with depression are more likely to talk about the physical symptoms of their depression rather than the emotional and psychological ones. It can help to be reminded depression is a result of chemical changes in the brain. Depression in men is nothing to do with being weak or unmanly, and it can easily be helped. If a depressed man is married, or in a steady relationship, his partner should be involved so she can understand what is happening. This will make it less likely for the male depression to cause permanent problems in their relationship. However, it is very powerful and works well for many men with depression. This will help to keep you physically fit and you will sleep better. It can also help you not to dwell unhelpfully on painful thoughts and feelings. Eat properly ??? a man with depression may not feel very hungry, but you should eat a balanced diet, with lots of fruit and vegetables. Avoid alcohol and drugs ??? Men with depression may find alcohol makes them feel better for a couple of hours, but it will make the depressed man more depressed in the long run. The same goes for street drugs, particularly amphetamines and ecstasy. These include exercises, audio-tapes, yoga, massage, aromatherapy etc. Do something you enjoy - Set some time aside regularly each week to do something you really enjoy - exercise, reading, a hobby. Check out your lifestyle - A lot of men with depression are perfectionists and tend to drive themselves too hard. You may need to set yourself more realistic targets and reduce your workload. Take a break - This may be easier said than done, but it can be really helpful to get away and out of your normal routine for a few days. Read about depression - There are now many books about male depression. They can help you to cope, but can also help friends and relatives to understand what you are going through. You may see situations and relationships more clearly and may now have the strength and wisdom to make important decisions and changes that you were avoiding before.