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Aging milestonesChanges in old age depends on attitude as much as person to person. In young old age some changes begin to take place in a person’s appearance. Wrinkles, warts, age spots begin to form on the body. Hair begins to thin or becomes grey and even height lessens because the bone density decreases. While in ‘old‘ old age these changes are already permanent. Men might look distinguished if in good health, but women all look grandmotherly. In ‘young’ old age, cells begin to decay and muscle mass declines and immunity is no longer as strong as it used to be. People lose energy as the age progresses.  ‘Old’ old age brings in a lot of physical decline, profound changes in appearance and motor abilities, as also in sensation. Skin gets less elastic and becomes thin and blood vessels can break under the skin. The senses also begin to become dull. Eye lenses get affected and color perception and reading ability becomes very low. Hearing loss may lead to paranoia and ‘old’ old age people begin to think everyone is plotting against them because they can’t hear properly about what others are saying. Sense of smell also declines, but the taste remains almost intact. In ‘young’ old age, reflexes also slow down and so do the motor abilities. By the time they reach ‘old‘ old age most adults find that their response time has become quite reduced. This can be seen most in driving situations where it is difficult for ‘old‘ old aged adults to operate their vehicles as they have poor spontaneous responses. The ‘young’ old adults do not lose as much of their motor abilities as the ‘old‘ old adults, especially when holding small things like needles and pins. Of course, there are changes in sexuality and there may be a decline in the ability to have sex as men may not have an erection and women become dry due to lack of female hormones. Cognitive decline in 40% to 60% of older adults can be arrested with remedial training. Despite all the changes, most people even in their 70s remain comparatively active if they do not suffer any illness. Mental, physical, and social activity is necessary to maintain the quality of life. Old people begin to withdraw from work and other important roles and allow the younger people to take over. They are a lot happier as is also advised in Vedic literature as vridhashram. While activities are important, disengagement is equally important. Memory loss becomes aggravated and other cognitive abilities begin to decline and there are many ‘old‘ old adults who get Alzheimer’s and lose the ability to look after themselves. Old people also dwell on questions of death and sometimes go through a phase of denial and then anger that they have so little time left. Acceptance of death comes, but after a struggle and the idea of losing the family saddens them. Old people require support in their declining years as they begin to lose their faculties.
Breast lumps- myths busted!The rise in the occurrence of breast cancer in women, since past decade or so, has made women, especially in the urban areas, very cautious about lumps in their breasts. Whenever there is a small lump in the breast, the first thought that comes to mind, is may be this is cancerous. However, instead of taxing your brain with worries, it is better to take action and consult your caregiver. Here are some of the myths that are regularly associated with breast lumps and the real facts related to the same. Myth: If there is a breast lump, it must be cancerous Statistics reveal that out of 10 cases of breast lumps in women, only 2 are cancerous. More often, these lumps are due to fibroadenoma or cysts. In many women, lumps are formed during the menstrual cycle and they go away after it ends. It is not simply possible to tell exactly what kind of lump it is, just by feeling through hands. However, it is important to detect the composition of the lump and to do so at the initial stages, so that if it is detected cancerous, early diagnosis and treatment can save your life. Myth: If your mammogram is normal, you are safe and the lumps are not cancerous This is not particularly true. To detect the presence of cancerous cells, you need to get more tests done; an ultrasound, an MRI and also a follow up mammogram, to get a second view of the lump. Doctors also suggest a biopsy to be 100 percent sure of the diagnosis. If the lumps persist but there is no detection, your doctor may ask you to keep doing the tests at frequent intervals, to assess the development. Myth: Malignant breast lumps do not cause any pain Although breast cancer patients do not suffer from much pain, this does not mean that if you do not have pain, the lump is non-cancerous. There are different types of breast cancers; and in some types such as the inflammatory breast cancer, the patient can suffer from warmth, tenderness, redness and swelling, followed by pain in the lumps. Myth: If you get a lump while breastfeeding, it is not cancerous It is true that breastfeeding reduces the chances of development of cancerous cells. But there is still a possibility and hence you should not ignore the formation of lumps. It is advisable to immediately get an ultrasound to confirm the condition of the lump. Myth: Lump in young women cannot be cancerous Women can develop breast cancer at any age. Hence, if you have a breast lump at a young age, or even if your teenage daughter has developed a suspicious lump in her breast, you should always get it checked, at the earliest. Most often, cancer develops in the breast when women are past their menopause period. But this, in no way means, that they cannot get it at younger age. Myth: Only a larger lump can be cancerous, not a smaller one Lumps in the breasts can be of all sizes; and the size, does not determine the presence of cancerous cells. According to breast-imaging specialist at New York's Manhattan Diagnostic Radiology, Melissa Scheer MD, you must immediately see a doctor, whenever you feel the presence of even a tiny lump, because, a small lump too may turn out to be aggressively cancerous. Most often, the lump in the breast is non-cancerous; however, it is advisable to consult your caregiver immediately, once you discover the lump for the first time.
Are you there for your teenage children?You must be there for your adolescent children so that they know who to turn to when they are confused. Being there does not necessarily mean your physical presence, but even the rules, boundaries, and standards of behavior you might have set should be able to guide them. When the teenager comes under peer pressure, then these rules may help them make the right choices. Teenagers live in fear They are frightened of their teachers, their friends; they are frightened of being mocked at or not being able to cope. They are dealing with a lot of issues, so when they come home, show them you care. They don't need parents screaming and shouting at them about their conduct or studies. The moment they come in, you should greet them with a smile, no matter what your feelings are otherwise. Don't expect your teenage children to be adults because they are still growing. Family is always important Most people think that teenagers no longer need the love, warmth, and support of the family. Your child might be a teenager,not a child to hold hands and show them the way, but they do need your support. A family works like an anchor that can pull back a teenager from being drifted away. Engage them.Speak to them regarding their likes and dislikes, the pressures they feel at studies, among other things. This could help them from the intense emotional turmoil they may be going through. Equation changes As a child you could cuddle your children, scold them, nurture and guide them, but as teenagers the equation might change. You may not cuddle your teenage child, but a warm hug now and then or a pat on the shoulder is enough to let them know that you love them just the same. Listen to them when they share an opinion. They want to prove themselves so follow their advice if it's reasonable so they feel they are an important part of the family and their opinions do matter. Don't treat your teenage children with suspicion.It will drive them away!! Moody If your teenage child is moody and uncommunicative, it does not mean that they don't need their family. It's just that friends might have taken precedence in their lives. Just the feeling that they have your support may encourage them to take their independent decisions. Information It is important to inform your teenage child regarding alcohol, drugs, and sex. However, you must also know they could experiment. So tell them about the dangers, and if they still make a mistake, then be there and do not abandon them. Help them get through the crisis. Teenage behavior Sometimes teenagers can behave erratically. It could be difficult to know if this is teenage moodiness or something more serious. As a parent you need to watch out for this and find out indirectly about what is troubling them. They might not open up immediately, but if you are around when they feel like chatting, they could let you know what is troubling them.
Lost in wonderland? - Absentmindedness!The Daily Telegraph reports that on an average every adult in UK forgets three things per day. Forgetfulness is a human tendency. If this absentmindedness or forgetfulness is limited to forgetting three to five things per day, then it can be left unattended. However, if you or a near one is facing a lot of trouble in your daily life due to this habit or problem, you should immediately have a consultation with your doctor. Mystery behind Absentmindedness According to Maria Jonsdottir, an investigating neuropsychologist from Iceland, absentmindedness is the mental lapses that usually happen in connection with the actions that are routine or well-rehearsed. You can perform these actions without any need to be careful. This includes regular actions such as squeezing out toothpaste or moisturizer from the tube. These action slips are very common and if you observe carefully, you do forget some such regular things every day unknowingly. Psychologists believe that an individual makes such mental lapses around 30 times in every week. On an average, the nervous system of a human brain runs quite efficiently. However, sometimes temporary fault may develop that may make you use incorrect word or slip to your native tongue while conversing. This does not mean however, that something is wrong with your brain. When the team of Jonsdottir surveyed around 200 people, they found out that on an average the slips are 6.4 per week although the number also greatly depends upon the gender, intelligence level, and age. One startling fact that was discovered is that most of the events of forgetfulness occurred before 8 p.m. that means people tend to forget more during the daytime than in the evening. Apart from a momentary lapse in the functioning of brain efficiency, other reasons that can lead to increase in the incidents of forgetfulness are high stress levels, mobile phones, e-mails, and busy lifestyles. Today, people are pressed for time and they have more work at hand than time and that has increased the occurrence of forgetfulness. Types of Absentmindedness A team of neuropsychologists has divided these mental lapses into five categories. The most common are the storage failures in which people cannot recall what they had planned for a particular occasion or they can recall the action, but cannot remember for whom it was meant. Another category is test failures in which people come back home to check whether they have turned the light off and find out that they have already done so. Discrimination failure is another category of absentmindedness wherein you for a moment fail to identify the difference between your things and others'. During the study, a male participant accepted that he picked up the jacket of his female partner thinking it to be his own. Sometimes you put books in the dustbin and the trash on the shelf and laugh at your behavior a moment later when you find out what you have done. This is discrimination failure. Another mix-up includes program assembly failure wherein you put salt in the tea instead of sugar or you just do not keep the right things at the right place. The fifth one is the sub-routine failure wherein you go to the market to buy tea and instead come back home with coffee. The research proves one thing that if you are absentminded, it does not mean that you have a bad memory or can suffer from dementia as is widely publicized in the media. It is perfectly all right to forget or being an absentminded person. Sometimes the incidences of absentmindedness can increase due to fatigue. A good sleep and rest can fix the problem easily.
Crave for non-food substances to put in your mouth? Go ahead take your pica!We all have strong cravings in some form or the other, especially for food. Just thinking of a chocolate cake or ice cream can set the mouth watering and the hand creeping to open the refrigerator. However, some people have an unusual craving and it is to consume non-food items. Everyone knows that children are known to eat chalk, dirt or lick walls but at times, even adults have this unusual craving for non-food items. This condition is termed as 'Pica'. One can understand a child popping something into its mouth as it's discriminatory skills are not developed, but what about fully grown adults who have this habit? Is it a mental ailment? One can't really call it a full blown mental condition as it occurs commonly in pregnant women. The cravings are as strong as any other food craving and sometimes these people go out of the way to satiate their cravings. So, right from paint thinner, to chalk to ink, ice, plaster, paint, linoleum to plastic bits can form the obsession or craving. Pica is a combination of psychological and biochemical processes and is generally a deficiency which sets about these intense cravings.  When pica strikes pregnant women, then it could be a cause for much concern and the doctor should be kept informed. While it is easier to indulge a pregnant woman's ice cream cravings if she also develops a thing for iron fillings on top of her ice cream, then obviously it can be a rather dangerous thing to do. Ice and chalk are comparatively harmless and other than affecting the teeth and the taste, do nothing much else, but what about turpentine and toxic materials? They can definitely interfere with the body's digestive processes and can even spread harmful toxins in the body to cause blood poisoning, intestinal infections, bowel blockages and lead poisoning or arsenic poisoning.  If you have such strong non-food cravings then before you give in to them talk about it to a medical practitioner. It could well be an iron deficiency or perhaps even anemia which is attracting you to chew pencils up or making you pop dirt in your mouth. If you are pregnant then certainly the doctor will need to address the underlying issue and ensure that the pica goes away before you deliver. Wouldn't want you chewing up the baby's soother now would we?
Fair skin - A modern obsession!History of Complexion - Complexion generally refers to the natural color, appearance, and texture of the skin, particularly on the face. Originated from the late Latin term 'complexio', complexion is traditionally referred to the temperament which was determined on the basis of the proportion of qualities of hot, wet, dry, and cold in the human body. It was believed that the body carried these qualities depending on the climate in which the individual lived. Thus, a person living in a cold climate was seen to have 'colder and moister' complexion and so on. The biological facet of complexion mentioned below tells us how the skin adapts its color according to the climate it finds itself in. Moreover, it was also seen to represent the character of the person into different categories like melancholic, choleric, sanguine, and phlegmatic. Complexion was the center which reflected the qualities which make a balanced person. Skin color is determined by the presence of pigment melanin. Located in the outer skin layer called epidermis, it is produced by cells called melanocytes. These cells contain receptors which are photosensitive and which detect the ultraviolet (UV) radiation from sun and other factors. In response to this detection, they give out melanin after exposure. The Biology of Complexion - The complexion of the body ranges from very dark brown of Africa and Aboriginal Australia to pink with yellowish hue of the Northern Europeans. In actuality, there is no skin which is black, yellow, red or white in absolute - it is generally a hue of many colors with one dominating over the other. Our biological actuality is not reflected by the words we use for our complexion these days. Skin color is determined by the presence of pigment melanin. This pigment is under the control of 6 genes. Both complexions of dark and light have melanin. Spatially located in the outer skin layer (called epidermis), it is produced by cells called melanocytes. These cells contain receptors which are photosensitive and which detect the ultraviolet (UV) radiation from sun and other factors. In response to this detection, they give out melanin after exposure. Those in tropical latitudes, where there is highest exposure to sun, have darker skin which contains melanin acting as a protective biological envelope against UV radiation. This protective layer prevents sunburns and other damages including those that could increase the risk of melanoma. The UV radiation reaching the earth increases during summers and reduces in winters. The skin adapts to this change by tanning - tanning indicates that your skin is increasing the size and amount of melanin grains to protect against the UV. Thus, your skin color is essentially determined by genetics and the geography of the place you live in. Biological Fact to Social Conclusion - We generally mold the biological fact of adaptability of our skin into a social meter of beauty. The complexion is a biological wonder of the nature which allows the skin to absorb enough vitamin D, prevent many illnesses like anemia, osteoporosis, and rickets determined by its environment. Thus, to claim that a certain skin color is superior to others is to only deny the reality of biology related to our skin and body, thus falling into the fallacy of unjustifiably jumping from a biological fact to a social conclusion. The health of your skin must be the starting point to declaring its beauty, not a presupposed social standard unrepresentative of the reality of the body. Taking Care of Your Skin - Every skin color is determined by its biological framework placed within the environmental setup. It is essential to take care of your skin to ensure that it is healthy and well taken care of : Make sure you eat a well-balanced and nutritious diet. Stay away from junk and heavily processed food items. Sleep for at least 7-8 hours daily to ensure that your skin gets enough time to recharge its mechanism. Drink loads of water to keep your skin hydrated. Go through the daily care routine: cleanse, tone, moisturize, and exfoliate. Use rose water to remove your make-up and ensure that you do not go to bed with make-up on. Keep dirt and germs away from your skin. The best way is to avoid touching your face with hands when you are out. A clean environment is the fertile ground for a healthy skin. Make sure you wash your pillows, their covers and clean the house regularly to keep away pollutants. Stress is one of the main causes of your skin's health withering. Your skin is the outer reflection of your inner mental state. Work towards mental detoxification to cheer up your skin and body.
5 Mistakes yoga beginners makeYoga is a science that has been developed by the ancient Indian sages after a lot of research and study. That is why yoga is difficult to master immediately and one needs a lot of practice to achieve every posture or asana in the perfect manner. So, it is very important to learn the yogic techniques from an expert and one must avoid performing yoga on your own, at least in the initial stages to ensure that you do not suffer from any physical injuries by wrongly straining or stretching your muscles during practice. Yoga can benefit you only if you perform the asanas according to right techniques. Hence, you should try to avoid mistakes right from the beginning. Here are the five most common mistakes people make while performing yoga as beginners: Learning How to Breath Inhalation and exhalation, some say is the most important process that you need to control while performing yoga. While trying to achieve certain asanas, you have to hold your breath for a while and because of this, your muscle fibers are deprived of oxygen for that time. And one needs to do this while holding one's body in that particular posture. With less strength in your muscles, there are chances that you may fall down or get injured. Hence, as a beginner, when you do not have proper control over your breath, it is best to inhale in short breaths, instead of going for the full belly breaths. Just as you slowly inhale, remember to exhale slowly as well, so that the rhythm of the yogic posture is not disturbed. Do not push Yourself Too Hard Most of the contemporary exercises are based on the principle of 'more pain, more gain'. These exercises tell you to stretch more and push harder to get the best results from your workout routine. However, in the case of yoga, the opposite holds true. If you push yourself beyond your limits to attain a particular posture in yoga, you might actually end up straining and injuring your muscles instead. . So, when you are doing yoga come what may, do not push yourself beyond your natural limits. Do Not Compare Some people are naturally gifted with super-flexibility, while the rest of us may not achieve it despite practicing yoga for years together. Each of us has a different type of body and hence, you should not try to compete with those who are highly flexible, especially, if you are trying yoga for the first time or after a long time. You must give your body some time to loosen up its rigidness and become flexible enough. Trying to compare your body's abilities with others and forcefully pushing yourself to perform postures, just to match up, will hurt you eventually. Where to Place the Mat? The best place to put the mat is at the back of your yoga class, especially if you are new to yoga. If you keep your mat at the front, you will become more conscious and will never be able to concentrate on the asana. Instead, if you are at the back, you will always have the front row to follow, just in case you miss the instructions by the instructor. Go easy on the Food! Yoga postures can be intense and if you go into class with a full belly, you will, most definitely find it difficult and uncomfortable to perform the asanas. The key is to eat about an hour before and almost half the size of your usual portion; so that you can perform the asanas comfortably and get the exact fuel necessary for performing them.
Aids defining cancersIn fact the presence of such aids defining cancers is an indication of advanced AIDS having developed in these patients. However, the reasons for these cancers are unclear. It is possible that since people with AIDS have low immunity, they become more susceptible to these cancers. The double attack of these already complex diseases complicates treatment plans too. Thus, it needs care under experienced doctors who specialize in these diseases. The cancers that define AIDS are: Kaposi's Sarcoma:This is a type of skin cancer. It was usually found usually in people who have received organ transplants. Nowadays it is also most prevalent in homosexual men with HIV/AIDS and is also called epidemic Kaposi's Sarcoma.  It causes lesions to show up in multiple points in the body such as skin, lymph nodes, liver, lungs, spleen and digestive tract. Non-Hodgkin Lymphoma:This is the second most commonly associated cancer with HIV/AIDS. The various sub types of NHL are primary central nervous system lymphoma and primary effusion lymphoma. Approximately 4-10% people with HIV/AIDS develop NHL. Other kinds of cancers are anal cancer, liver cancer, mouth cancer, Hodgkin's lymphoma, testicular cancer, melanoma, throat cancer, colorectal cancer and multiple skin cancers.  Treating Cancer in HIV people: Till anti-HIV medication were not discovered the future for infected people was bleak. They were already sick and their bodies weak even before their cancer treatment were started. Presently the cancer treatment is mixed with anti-HIV drugs. However, depending upon the extent of cancer and the need of AIDS care, variations are made between chemotherapy and other HIV related drugs needed. Treating Kaposi's Sarcoma: Often anti-HIV drugs are enough to treat this cancer. The lesions, which are viral, shrink, as the immune system gets better. Sometimes chemotherapy and radiation may also be needed if the lesions are internal. Treating Non-Hodgkin Lymphoma: AIDS related NHL is fast growing and needs intense chemotherapy treatment. Introduction of highly active anti-retroviral therapy and use of drugs that help the infected body make new blood cells has relieved a major concern for HIV patients where previously due to their low blood cell count, chemotherapy could not be administered to them. But with these advances, acutely monitored chemotherapy treatments can be administered now. Treating Cervical Cancer: In case of women who have a good immune system and invasive cervical cancer can still be treated similarly as non-HIV women. They can even do well in surgeries and other conventional treatments. Discovering Cancer Early: Screening helps discover presence of cancer when no symptoms are evident. However AIDS defining cancers cannot be detected through screening. Thus, close monitoring, regular checkups and a keen lookout for symptoms of these cancers can help discover the ailment if present. Pap tests help discover cervical cancer in women. However, in case of HIV women, these should be undertaken more often. Even as often as 2 tests a year, 6 months apart in the first year of HIV detection. If the tests are clear, they should get Pap tests done regularly once a year henceforth. For other AIDS related cancers, the screening tests are still being devised. Lowering Cancer Risk: HIV ruins the body's immune system making it susceptible to a variety of diseases. Good health practices are a must for those detected with HIV in order to ward off cancer. They should surely not smoke or consume alcohol. Injection drugs and unsafe sexual practices also pose increased threat of cancer. Maintaining balanced diets, physical activity and proper body weight are extremely important and helpful too.
A primer on heart attacksIndians around the world have one of the highest rates of heart diseases. Heart attack, also called as myocardial infarction, is mainly caused by a blockage that prevents oxygen-rich blood supply to your heart muscle. In other words, it is the death of the heart muscle. What causes a heart attack? When cholesterol deposition, plaques of calcium and proteins on the walls of your coronary artery cause blockage of the artery, your heart fails to receive sufficient nutrient-rich blood. This leads to the permanent death of heart muscle, and it is unable to pump the blood to your vital organs. Symptoms that signal a heart attack   Chest pain is a symptom of a heart attack.  This pain can feel like tight ache, pressure on the heart as if an elephant is sitting across the chest. However, you may get confused with the symptom chest pain - whether it is a heart attack or an angina pain. Chest pain lasts for a longer time in heart attack whereas the chest pain in angina lasts for few seconds and goes away after rest. The pain experienced during a heart attack sometimes feels like indigestion or heart burn. Other warning signs of heart attack are: Shortness of breath. Lightheadedness or fainting. Upper body discomfort in arm, the back, neck, and jaw. Nausea, vomiting, dizziness. Sleep problems or fatigue. Not every person will have the same symptoms of the heart attack. But if you have any of these warning signs, you have to act fast and get the right treatment.
Know your safe period for low-risk sexNot every act of sexual intercourse will result in pregnancy. There are days when your chances of conception are very high and days when the chances are almost nil. Know these days to help you enjoy a rocking sex life! The menstrual cycle starts from the day the bleeding starts and ends about 28 days after that, on an average ovulation occurs around 14th day of the menstrual cycle. The 14th day is the ideal day theoretically. Since every woman's menstrual cycle differs, the day of the ovulation also differs. Hence doctors calculate the fertile period as the 12th day to the 18th day of the menstrual cycle. This is the period when the chances of ovulating and hence getting pregnant are very high. The 1st to the 7th day and the 19th day to the start of the next cycle are the days when the ovulation chances are very less. This means if you make love during these days, there are very less chances of getting pregnant. This is the case with women who have regular period cycles. In case the cycles are irregular, then you would need to do a bit of math for calculating the safe period. For example, if your shortest cycle is of 26 days and the longest cycle has been of 31 days, then- 26-18= 8 and 31-10=21 The 8th day to the 21st day are the fertile days; 1st day to the 7th day and then the 21st day until the day the next cycle starts are the days that are safe to enjoy sex without fear of getting pregnant. Opting to have sex during the 'safe period' isn't fool-proof though. A lot of women have irregular cycles and the cycle length can vary from women to women. That's why the so-called 'safe period' is, in truth, not that safe! And it's better to use condoms or other contraceptive methods like the oral pill to prevent unwanted pregnancies.
Painful intercourseSome of the causes affecting women can be: Going too fast, penetrating from an awkward position. Do not hesitate to tell your partner that it hurts and he needs to slow down or change position in order to make you comfortable and prevent pain. Dry vagina or lack of natural lubrication in the vagina. This dry vagina is caused due to some medications, changes at the menopause. Sometimes just increasing the time of foreplay can help vaginal lubrication. Use water-based lubricant to reduce pain. Failure to fire off. Sometimes failure of the vagina and uterus to respond to sexual arousal can lead to irritation and tenderness. The vagina may be too tight for the intercourse sometimes or the uterus may not be raised so that the penis comes in contact with the cervix during penetration. Using other penetration methods can be helpful to explore the level of arousal before engaging in intercourse. Vaginismus can be the cause of discomfort. Muscles surrounding vagina are sometimes very tight and lead to pain and intercourse to be painful. Woman can examine herself with her fingers to see if vaginal walls are tighter than normal. It can be vaginismus. Normal cause is nervousness or anxiety. It is reversible. Good foreplay before intercourse will help to relax the muscles and help lubricate. Just relaxing before the act can be helpful. Vaginal infection and inflammation due to yeast, herpes, etc. can make intercourse uncomfortable. Fabrics, creams, perfumes may cause irritation in area in some women. Avoid these. First-time sex can be a little painful. Rupture of the hymen can cause discomfort during penetration. Start slowly or begin with forms of penetration other than intercourse. Psychological pain. Sexually traumatic experiences or feelings of guilt associated with sex can make the act painful. Consult a sex therapist or psychiatrist. Discomfort during intercourse is experienced by men too, various causes affecting this outcome for men are: Tight foreskin. During first attempt at intercourse, tight foreskin will make retraction painful. After sometime, the foreskin will become loose and make intercourse comfortable. Any lesion on the penis skin can make intercourse painful. These may result from non-lubricated masturbation or rapid intercourse or STDs. The blisters due to herpes infection can make intercourse extremely painful.
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