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Sex and Some Change

Saturday, February 14th, 2009

Q: Me and my boyfriend plan to marry after school. I really love him and I really want him the same way he wants me, but I am scared about if we have sex then he leaves me. I don’t want to lose him.

A: There’s no sense in being anything but frank.

Sex does tend to change things.

It can bring about or illuminate changes in the relationships it occurs within, changes in our other relationships, and changes in ourselves. Often, we have to add some factors to our lives we may not have had to before, like adding the use of birth control or safer sex, getting sexual healthcare, talking about sexual limits, boundaries and desires, negotiating sex or navigating through sexual conflicts or issues. Obviously, certain results or consequences of sex, such as a pregnancy or a sexually transmitted infection, can also create physical changes, as well as changes to our lives and relationships.

Sometimes those changes aren’t even negative things, like losing someone, winding up with Herpes or discovering that sex just doesn’t feel good or right between you. Sometimes those are neutral or positive changes, like discovering new and pleasurable things about yourself or your sexuality (or about your partner and his sexuality) you didn’t know before, getting a boost to your body image, winding up with a wanted pregnancy, or having a relationship go to a new and bigger place, but they are still changes, all the same, and sometimes we’re just not at a time or place in our lives where we feel best able to deal with big changes. This is why, in the Sex Readiness Checklist we have at Scarleteen, one of the questions we suggest people ask themselves if if they feel able to handle any changes sex may cause.

As well, with any relationship we are in, that relationship changing, coming to an end, or any one party leaving is always a possibility, whether we have sex or not, whether we (when we can) marry or not.

There is absolutely nothing any of us can do to assure that a given person stays with us, or stays in a certain relationship with us.

Whether sex is part of the picture of not, life changes things, and time changes things. People change and relationships change as we live, learn and grow, and there is no magic formula or list of things to do or not to do — nor an order to do things in or not — which can put you in complete control of that. One of the trickiest parts of love and relationships is that while they can feel eternal, and while we may have times when we want a certain way we feel, or place we’re at in a relationship, or person to stick around forever, if we can count on any one thing in our lives, it’s change, and that fact that nothing really lasts forever.

So, in my book, the way to approach that is to value our feelings as much as we can while we have them, and to love and honor the people who are in our lives while they’re here as best we can. I also think it’s sage and caring to try and be flexible and open enough that when — as we all tend to — each of us changes, we can still love each other and be in one another’s lives being more attached to who people are than to what exact kind of relationship we are in with them. (And if you talk to older couples who have been together and happy for a very long time, you’ll hear many say that in a long-term marriage, that kind of flexibility is key.) By all means, when you find something marvelous you want to commit to as fully as you can, and really put your whole heart into, I say go for it, since that’s so much of what really living life is about, but also understand that trying to always telescope all your actions based on what will keep someone around can, at a certain point, get in the way of fully experiencing and enjoying what you have while you have it.

What I seem to hear you saying, though, in regard to sex, sounds to me like you are feeling that it is very important to you to assure — for as much as you can — that when you have sex, you do so in a relationship with someone who is committed to staying in the relationship with you after sex. That’s hardly an uncommon thing for a person to want: many people feel that way, and that’s absolutely valid.

Maybe for you, that means you’d prefer to save sex together for after marriage: if that’s what feels best to you, you get to do that. Or, maybe you need to sit down and have a deep conversation with your partner about your concerns, and if you very strongly feel you want to have sex before marriage, but are fearful about him leaving, see how he feels about that, and find out how committed he is to sticking with you no matter what sex might change for each of you and between you. In doing that, you can also provide him the opportunity to talk about his own fears and concerns, which you’ll want to be sure get addressed just like your own.

It sounds to me like you’re expressing feeling pretty fearful about this right now, and I know for myself that when I feel very scared about doing something which is absolutely optional — and sex is, and always should be — I find it best to take more time to work out how I feel about that thing and how that thing may or may not really suit my needs before I go ahead and do it.

So, my personal suggestion to you would be to take some more time to sort out your feelings and talk with your boyfriend before you become sexually active.

Not only does that make it more likely that you’ll make the best choice for you, but sex when you’re fearful simply does not tend to be very enjoyable or enriching: our minds and bodies don’t tend to experience a lot of pleasure when we’re scared or freaked out, and it’s also tough to be open enough to really get close to someone during sex when we’re scared. The time when it’s going to be most right for you is when it’s not this scary, and clearly, when you feel a bit more secure in your relationship than you do right now, and have developed more trust than you have in it right now. An intention to marry or a promise of marriage in the future can’t automatically create things like trust and stability with where you’re at (it’s sage to say that marriage is more about a demonstration of those things as they already exist): it sounds to me like it might be a good idea for you, in your decision-making with this and in general, to think less about a future marriage and more about where you’re at, how you’re feeling, and what you need to feel more secure in your relationship today.

Don’t forget, too, that sex is not just intercourse. The only two big differences between vaginal intercourse and all other kinds of sex is the risk of pregnancy, and the fact that some people simply attach more importance to vaginal intercourse for personal, religious or cultural reasons, particularly before they have it (afterwards, it can tend to be clearer just how different from other kinds of sex it often isn’t). In other words, if you are doing things like making out, or having manual or oral sex, then you already are going to have some idea of how things are going when it comes to sex and the two of you. If you are doing those things, you can look at how those have been going, and if it seems like the sex you’re already having in your relationship is working well within it and leaves you feeling good — not just physically, but also emotionally — or not-so-great.

Again, no matter what, you can’t have a guarantee that any choice you make will assure your boyfriend stays your boyfriend, becomes your husband or sticks around: there is just nothing you can do to assure that. Heck, maybe you’ll find that it’s you who thinks about leaving him at some point; maybe it’s you who will find that sex changes how you feel about him, your relationship, yourself or your future plans. Maybe you two will have some changes in your relationship — or that one of you will decide not to continue on with it or a marriage — over something that isn’t about sex at all. While you can’t have that guarantee, you can manage this in a way which is most likely to keep you and your relationship in a good place.

You’re the best expert on knowing when something is right for you, and when you feel up to handling something and when you do not. You can certainly act in ways which are most likely to benefit your relationship and its quality, such as being honest about your fears, voicing your own needs and working with your partner to assure that sex is something you both really want, and feel ready both to manage and enjoy. The bonus is that doing that not only helps you make the best sexual choices that you can, it helps nurture and grow more love in your relationship as a whole.

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How Do You Get Herpes Gladiatorum?

Friday, February 13th, 2009

This skin infection is spread by direct skin-to-skin contact. Athletes participating in sports that involve close contact can spread this infection to other athletes.

Symptoms

Lesions appear within eight days after exposure to an infected person, but in some cases the lesions take longer to appear. Before skin lesions appear, some people have a sore throat, swollen lymph nodes, fever or tingling on the skin. Herpes gladiatorum lesions appear as a cluster of blisters and may be on the face, extremities or trunk. Seek medical care immediately for lesions in or around the eye.

Prognosis

Herpes gladiatorum infections can recur. The virus can “hide out” in the nerves and reactivate later, causing another infection. Generally, recurrent infections are less severe and don’t last as long. However, a recurring infection is just as contagious as the original infection.

On alert

Schools whose wrestlers have come in contact with Wantagh during recent meets and whose athletic directors have been notified:

* Bayport-Blue Point
* Bay Shore
* Brentwood
* Center Moriches
* Central Islip
* East Islip
* Mattituck
* Mt. Sinai
* Rocky Point
* Valley Stream South

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What Is Mat Herpes?

Thursday, February 12th, 2009

Herpes gladiatorum, which has been found in a Wantagh High School wrestler, is a skin infection caused by the Herpes Simplex Type 1 virus and commonly occurs among wrestlers.

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Precautions Taken After Case Of ‘Mat Herpes’

Wednesday, February 11th, 2009

The Wantagh High School wrestling team postponed three scheduled events this week after an athlete was diagnosed with herpes gladiatorum, a herpes simplex virus commonly known as “mat herpes.”

Wantagh participated in the Rocky Gilmore Tournament at East Islip last Saturday and contacted the host school, which in turn notified officials of the other schools that took part in the tournament.

Wantagh postponed its Nassau Conference 3A dual meet at Lawrence on Wednesday evening and tonight’s dual meet at Bethpage. The Warriors also notified the William Floyd district officials of their withdrawal from tomorrow’s prestigious Kujan Brothers Memorial tournament in Mastic Beach.

“We shut it all down until we are sure that everyone is safe,” Wantagh wrestling coach Jim Murphy said. “We sent our entire team to the doctor to get checked out head to toe. This is an issue that has to be taken very seriously and addressed immediately.”

“We were notified by Wantagh that one of their wrestlers was diagnosed with herpes,” East Islip athletic director Pete Blieberg said. “We contacted all of the schools that participated in our tournament. And we also sent a letter home with each one of our wrestlers which included an information sheet that describes the strain of herpes and how it is contracted.”

Athletic directors at Bayport-Blue Point, Central Islip, Rocky Point, Brentwood, Mt. Sinai, Bay Shore, Valley Stream South, Mattituck and Center Moriches were notified about the infected wrestler, Blieberg said.

Blieberg said due diligence is paramount in these situations to prevent a wider range of cases.

“This isn’t due to anyone’s negligence,” he said. “This is one of the risks involved with wrestling. It’s a very common form of herpes because of the direct skin-to-skin contact. Hopefully, it’s an isolated incident.”

Mt. Sinai assistant coach Keith Wagner had addressed an open wound on the Wantagh wrestler’s neck during Saturday’s tournament. Murphy said he placed a large bandage over the area to keep it covered. Wagner questioned the abrasion but the tournament continued.

“It apparently got worse over the weekend and his parents took him to the doctor on Monday,” Murphy said. “He’s currently taking Valtrex and is expected back wrestling on Tuesday.”

Murphy said all of Wantagh’s wrestlers were given Valtrex as a precautionary measure.

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Is Shingles Contagious?

Tuesday, February 10th, 2009

A common concern is whether the infection is contagious. The irus that causes herpes zoster is the same virus that causes chickenpox. The blisters associated with shingles are teeming with varicella, and any direct contact with that fluid can transmit the virus. Herpes zoster is not spread through sneezing, coughing or casual contact, but chickenpox (varicella) is. Therefore, people with shingles can spread shingles during direct contact with fluid during the blister phase. Once the lesions scab over, they are no longer contagious. Patients with shingles must avoid people with weak immune systems, pregnant women and babies who have never had chickenpox.

Chickenpox, on the other hand, is usually airborne and therefore highly contagious. When a person with shingles comes in contact with someone who has never had chickenpox, exposure can lead to chickenpox (not shingles). Here is an example: A grandmother who has active shingles babysits her grandchild, and the child develops chickenpox within the week.

Only people who have had chickenpox can develop shingles. Herpes zoster is not caused by the same virus that causes genital herpes, a sexually transmitted disease.

Prevention

A vaccine is available to help prevent herpes zoster. It should not be confused with the chickenpox vaccine, which is a separate entity and greatly reduces in the incidence of chickenpox in children.

Zostavax is indicated for use in people 60 years and older to prevent the development of shingles. The vaccine has no effect on active shingles and does not treat PHN. The CDC has stated that the vaccine is safe and effective for the prevention of herpes zoster and PHN in older adults.8In a clinical trial of 20,000 people 60 and older, Zostavax prevented shingles in about half (51%) of patients and prevented PHN in 67% of patients.7Insurance coverage for Zostavax varies. The vaccination is recommended for all people older than 60, even those who have had shingles.9

Putting It Into Practice

Herpes zoster tends to strike as immunity declines with age. The pain associated with shingles is of particular concern. In most young patients, the pain is transient and bearable. But in older adults, shingles-associated pain is often more prolonged and more intense.3

Physician assistants are responsible or prompt and early diagnosis, early treatment with antivirals and emotional support in the presence of acute and chronic pain. Most importantly, it is our duty to inform all older adults about the availability of a vaccine.

Helen Carcio is a women’s health nurse practitioner who owns the Health and Continence Institute in Deerfield, Mass. She is a member of the ADVANCE for Nurse Practitioners editorial advisory board and is a recipient of the Continence Care Champion Award from the National Association for Continence.

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Herpes Zoster Treatment

Monday, February 9th, 2009

There is no cure for shingles, but prompt therapy may shorten the duration of external manifestations and, more importantly, limit neuralgia. Antiviral therapy is effective and should be initiated within 48 to 72 hours of symptom onset or as soon as possible after the rash appears.1 dministering therapy within the effective time frame is often difficult because the disease usually is not diagnosed until the rash appears.

Three oral antiviral agents are available to treat herpes zoster. The two newer agents are famciclovir (Famvir) and valacyclovir (Valtrex). Acyclovir (Zovirax), the oldest agent, differs from the other drugs in that it must be taken five times a day rather than three. Each of the drugs must be taken for 7 consecutive days. No evidence suggests that initiating therapy after the first 48 to 72 hours of symptoms is beneficial.6 owever, in an effort to shorten the disease course and prevent PHN, most providers prescribe antivirals as soon as the diagnosis is made, even outside the 72-hour window. More research is needed.

Pain relievers are a vital part of the plan of care for shingles. OTC analgesics and NSAIDs can be effective, but stronger prescription pain medications may sometimes be necessary. Other medications, such as pregabalin (Lyrica) and gabapentin (Neurontin), are approved for the treatment of nerve pain associated with PHN and can be quite effective at managing associated discomfort.

Thankfully, shingles usually occurs only once in a lifetime. In rare instances, a second round may occur years later. This second bout usually involves a different dermatome.

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Herpes Zoster Symptoms

Thursday, February 5th, 2009

The symptoms of shingles vary and are often vague. Patients typically feel them before they become apparent to visual observation. Symptoms first appear as flu-like symptoms – typically headache, nausea, sensitivity to light and, less commonly, fever. A generalized skin sensitivity develops and is present for a few days, followed by a readily identifiable rash. Pain along the course of a dermatome surfaces soon after the rash appears. Typically, only one side of the body is affected (reflecting the affected nerve root). But more than one dermatome on the same side may be involved.

Because the early symptoms of shingles mimic other conditions, the disease often is not diagnosed until it progresses and vesicles appear. For example, patients whose thoracic nerves are affected may suspect they are having cardiac or respiratory problems. Dermatome L3 runs across the lower back to the top of the hip, and symptoms in this area can be mistaken for appendicitis or a severe lumbar strain.

The first sign of a shingles attack can be isolated pain or numbness along a nerve or under the skin, or a shooting pain around the trunk, up over the face, or down the arm or leg. Allodynia – the severe discomfort that arises with such normal occurrences as clothes rubbing against the body or water striking the affected skin – is another common manifestation.

The shingles rash usually erupts 48 to 72 hours after the onset of nerve pain. The lesions of shingles appear along the dermatomes in the thorax or lumbar area, and they typically appear as a band or strip on one side of the body or as clusters extending on one side of the face and scalp in an area where the patient previously experienced pain. Less commonly, shingles rash can occur in the ophthalmic branch of the trigeminal nerve.

The typical shingles rash begins as a single blister, and it progresses in a linear fashion. The lesions first appear as an erythematous, macular-papular rash that rapidly develops into vesicles that coalesce and fill with fluid. The lesions continue to form for the next 3 to 5 days. The fluid associated with the blisters changes from clear to cloudy as the white blood cells absorb the varicella virus. Eventually the blisters heal and scab over. Scarring does not typically occur unless the lesions become infected.

Although shingles lesions are unsightly and may itch, a more bothersome problem is the accompanying nerve pain. Patients often describe the initial dermatome pain as stabbing or prickling, with some numbness and burning. (See the sidebar for my experience as a patient affected by shingles.)

The blister phase usually subsides after a few weeks, but the next phase can feature the infection’s most dreaded consequence: postherpetic neuralgia (PHN). This is the persistence of pain beyond integument healing, or symptoms lasting more than 1 to 3 months after disease onset.

PHN pain, which patients often describe as burning and tearing, is chronic and persistent. Fifty percent of shingles patients older than 50 experience debilitating PHN pain for more than 1 month.5Sometimes, this pain lasts for years.

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Herpes Zoster Alert

Wednesday, February 4th, 2009

Shingles, also called herpes zoster, is a viral infection caused by the varicella virus. Data show that 95% of Americans contract chickenpox (varicella) by age 18 and that nearly 30% are affected by shingles before age 85.

Etiology

Shingles infection is more common in people older than 60, but anyone who has previously been infected with varicella in the form of chickenpox can develop shingles. The theory is that the varicella virus remains dormant in the cells of the peripheral nerves and is triggered by something that awakens or reactivates the virus, causing it to re-emerge in the form of herpes zoster years later. What prompts the virus to awaken and cause problems in otherwise healthy people is not known. The term “zoster” refers to the dermal and neurologic components of the infection.

The majority of people who develop shingles are usually otherwise healthy. Regardless of this tendency, always evaluate patients with shingles for the possible presence of an underlying disease state that may influence its development. This includes conditions that alter the immune system, such as AIDS or cancer. Patients who have received chemotherapy or radiation treatments may also be at higher risk for developing shingles.

Family history appears to play a role in herpes zoster. A recent study of 504 patients treated for shingles found that the patients were 4.35 times more likely than control patients to have a first-degree relative with a history of the infection.

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Recurrent Herpes Outbreaks

Tuesday, February 3rd, 2009

Of those people who experienced an outbreak of herpes sores when they were first infected, 80% will go on to have recurrent outbreaks. Although these outbreaks tend to be less severe and shorter in duration than the first outbreak, they can still be just as uncomfortable. Additionally, a person is more likely to pass on the virus when they experience an outbreak.

Prior to the recurrent breakout, though, many individuals tend to experience “warning symptoms” that they are about to have another herpes episode. Often, an individual will have some pain or discomfort in the area that is infected before their herpes sores develop. During this time, you are considered to be very contagious despite the absence of herpes blisters.

Herpes Treatment

Although there is no herpes cure, there are various herpes medications available that can ease the discomfort of your symptoms and shorten the length of the herpes outbreak.

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Genital Herpes Symptoms

Thursday, January 29th, 2009

The most common sign of herpes is red, sensitive skin that develops sores or blisters (often referred to as herpes bumps). These lesions usually show up in and around the genital area, although female symptoms of herpes may cause these blisters to develop inside the vagina. Other signs and symptoms of genital herpes include:

* Swollen lymph glands in the groin
* Headaches
* Muscle aches
* Fever
* Lower back pain

In women, herpes symptoms can also include vaginal discharge and pain or a burning sensation when urinating. About 25% of women will develop meningitis as a complication of their first herpes outbreak while another 10% to 15% will have troubles urinating because of their herpes.

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