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Weight gain and prostate cancerOne of the hormone therapies involves increasing the production of LH-RH. Luteinizing Hormone-Releasing Hormone (LH-RH) is a hormone which is produced by your body. This lessens the production of testosterone. The drug given induces the generation of this hormone. One of the side effects of this therapy is weight gain. Along with this, breast pain, hot flashes, nausea, and growth of male breast tissue might occur. Apart from hormone therapy side effects, the presence of fatigue can also stop a patient from regularly exercising, thus, resulting in gaining weight. However, it is important that this weight gain is averted as the chance of cancer returning is a possibility. You can keep your weight in check by following these tips: Ask your doctor if your hormone therapy can lead to weight gain. If you receive an affirmative answer, then ask for a diet chart to be followed. You can also keep a food and activity journal to get an idea of how your body is reacting to the treatment. Inculcate physical activity in your schedule. This will not only help to reduce fatigue, but also keep at bay the chances of becoming constipated or feeling nauseous. Medical studies have shown that cancer patients must have at least 2-1/2 hours of moderate physical exercise per week. Have about 2.5 cups of fruits and vegetables every day. Also, shift to whole grain food items. You should also consume at least a cup of legumes, for example, beans, to keep up your protein levels. It is best to opt for lean protein snacks like yogurt and chicken. You must stay adequately hydrated during your treatment. Drink about 10 to 12 glasses of water everyday. Do not consume excessive amount of sweetened beverages like coffee and cola. Have a small portion of nut and nut seeds. If you feel distressed due to the therapy, go for a massage. These have been proved to reduce anxiety and stress caused during the treatment of cancer. Most importantly, keep up with your appointments with the doctor and convey the bodily changes that you may notice. Have an optimistic outlook towards the treatment and do not repress any emotional disturbance. Weight gain in men who had been previously healthy often leads to depression regarding weight issues. Being proactive and focusing on keeping your weight under check is the key here. You could also approach a psychologist if you have been feeling low. The LH-RH therapy is also known as Androgen Deprivation Therapy (ADT). This therapy leads to a weight gain of around 9 pounds within a year of starting treatment. You can make sure that your weight is controlled by altering your lifestyle and getting adequate physical exercise everyday.
Menopause and mental health!Menopause is the period in a woman's life when her man claims she is going crazy. It is also the time when her period is on the decline and hormones are in complete disarray. Depression, insomnia, irritability, mood swings and lack of concentration are few symptoms that the lady has to battle with. These symptoms may begin as early as 4 years before the actual menopause and may continue for several years after that! For women, menopause is a significant turning point in their lives. The dropping levels of oestrogen and the resultant physical and mental symptoms can be like a cycle of events, only adding to their woes! Depression: Depression affects every middle-aged woman. An estimated 20% of women have depression at some point during menopause. The peak period for depression is during the perimenopausal years, when the woman is approaching menopause. The reason for this, say experts, is the fact that most women dread menopause. Even though for some it means an end to years of menstrual cramps, for most others it signifies an end to their womanhood. The very idea is sufficient enough to bring on lots of negative thoughts and depression. Not only this, the reason for depression during perimenopausal and menopausal age is the fluctuating hormones. Research shows that the levels of reproductive hormones, specifically oestrogen are responsible for the mental changes. Changes in the sleep pattern: Insomnia is seen in 40 to 50% of women in the menopausal transition phase. Women who spend sleepless nights are more likely than others to show irritability, crankiness, stress and depressive symptoms. Sleep disturbances during menopause have been linked to the decreasing oestrogen levels. Indeed this claim can be held true as several women respond positively to exogenous hormone therapy. One study claims that sleep changes are linked to the Luteinizing Hormone levels, which also results in increased body temperature. Sleep apnea too occurs in the menopausal transition age. This is due to decreased progesterone level, as progesterone plays an important role in respiration. The weight gain that happens during menopause has also been shown to cause sleep apnea. Panic disorder: Panic disorder is commonly seen during the perimenopause stage. Existing disorder may worsen or new disorder may arise. Panic disorder is usually manifested in women who show several physical symptoms of menopause. The panic attacks are usually associated with negative life events, pre-existing medical diseases and decreased daily functionality. Obsessive compulsive disorder: New onset of OCD, worsening of the existing condition or change in the pattern of symptoms is seen during menopause. OCD changes are also observed during pregnancy and during the menstrual changes, suggesting the impact of hormones on symptoms of OCD. Bipolar disorder: Women with bipolar disorder experience an exacerbation of symptoms during the perimenopausal stage. These women are also the ones that are highly likely to experience severe depression in the menopausal phase. Schizophrenia: Schizophrenia usually manifests itself in young adulthood. The rate of new cases decreases gradually thereafter, in both men and women. In women, however, there is a second peak in the 45-50 years age group. This peak is not observed in men. This suggests that oestrogen may play a significant role in triggering schizophrenia or worsening the pre-existing condition.
The post-delivery bluesA baby being born is cause for celebration. Especially in a country like India, where the family ties tend to be close, there is a festive atmosphere at home. However, sometimes the mothers may not share the same enthusiasm. This wave of negative emotions in the middle of what is clearly a happy occasion can be confusing for the new mother. Interestingly these feelings are not abnormal, as many new moms face postpartum depression, which is also called baby blues. It is an emotional reaction that begins a few days after delivery and lasts not more than 2 weeks. What are the symptoms of postpartum depression? Feelings of anger or irritability. Lack of interest in the baby. Lack of appetite and sleep disturbance. Crying and sadness. Irritability or hypersensitivity. Feelings of guilt, shame or hopelessness. Loss of interest, joy or pleasure in the things you used to enjoy. Possible thoughts of harming the baby or yourself. What are the causes of postpartum depression? Postpartum depression can occur due to a combination of factors. Hormonal changes: Changes in the level of hormones can leave you feeling tired, sluggish and depressed. Changes in your blood volume, blood pressure, immune system and metabolism can contribute to fatigue and mood swings. Emotional factors: Feeling overwhelmed with the new arrival in the family, and taking care of the baby day and night, may leave you sleep deprived, overexerted, and anxious. New mothers also feel that they look less attractive after pregnancy. You may feel that people around you are concerned with the baby more than you, and that you are being neglected. All these emotional factors may lead to postpartum depression. Other factors: Issues like breast feeding, financial strain, and relationship troubles can also contribute to postpartum depression. How does one deal with postpartum depression? Take complete rest and sleep for sufficient hours Spend quality time with your husband Go for healthy diet Take morning or evening walk for fresh air Try to follow yoga or other exercises Share your feelings with your husband or friends Do not overexert Join some groups for new moms Go for individual therapy or counsellors Remember, postpartum depression is not an incurable problem. It is just a temporary state of mind, which can be overcome if you are sufficiently aware of the problem.                
Teenage troubles for autistic kidsTeenage brings along with it a lot of physical and psychological problems. Your body undergoes a lot of changes, the way the world looks at you is changing and you are not in the position to accept all this. Teenage is one of the most painful periods in one's life.  For an autistic child teenage can be compared to living a nightmare day in and day out. Here is a look at the problems of teenage from an autistic kid's point of view: Social Interaction The ability to interact socially is absent in autistic kids. They are loners who prefer to be left alone and undisturbed in their own worlds. Such a child is a natural target for bullying and ragging by other kids of his age group. At times even if the autistic child wants to come out and make friends, he is not able to do so due to lack of the required skills. Teenage is a period where you need at least one friend to confide in. It can be an extremely difficult phase when you are all alone. Puberty This is the dramatic time in life dilled with hormones and emotions. Your body undergoes lots of changes and you are confused about so many things. You don't know whom to ask or whom to turn to for guidance. Autistic children do not have the maturity to understand this phase. Special issues for autistic teens and sexuality include: Knowledge of physical changes in body. Knowledge of 'good' and 'bad' touch. Ability to communicate about a 'bad' touch or action. Keeping 'safe' distance from others. Handling menstrual cycles. Avoiding 'self-touch' in public. It can be a phase of emotional turmoil for the parents. They need to work closely with their child's special teachers to chalk out a plan that will be best suited to the child in handling puberty successfully. Self-help skills Simple self-help skills like hygiene can be a challenge for teenagers with autism. Improper motor skills, compliance, and sensory problems may interfere with a teen's progress. The proper training of hygiene and grooming can help to add these elements into the daily routine. The right approach is to simplify each task into simple small steps. The positive reward system is a great source of encouragement, as positive motivation always help the teenagers. Higher Functions Autistic teenagers are socially awkward. They lack the power to comprehend and process complex social cues which includes sarcasm, body language, humor, emotional responses and facial expressions. What complicates the problem is that the autistic child lacks empathy and hence may appear rude. Such kids are likely to be teased a lot in school settings.
Stress - Even kids cannot escape!Often when we feel overwhelmed with stress, we go back in the past and reflect. We miss our golden days of childhood.We think of those days with fondness, miss the free and carefree times. We feel like becoming kids again. But the truth is that at no age are we free of stress and worries. It is just that with time, we move on to newer situations and every new stressor seems worse than the previous one. Children stress out too, some more than the others. Stressors Simple things like a test in school, a Physical Training class or poem recital could mean a lot of stress for the little ones. The desire to meet the expectations of parents or teachers also creates tremendous pressure on the children. They are eager to do well at all the times and the smallest failures can upset these kids immensely. Peer groups are difficult to manage. In childhood, the social maturity is not sufficiently developed to handle day-to-day conflicts. Trivial fights or comments from classmates and friends can lead to a long-lasting impact on the vulnerable minds. They get easily influenced by their friends. Elder siblings also play a major role. Some act as mentors, some as bullies. Some cause damage unknowingly, some are plain indifferent. Life is full of new things and childhood is a fast-track learning lesson. Every other day, there is something new a child has to do. Meet a new kid, learn a new subject, try to dodge a ball differently or ride a bicycle without side wheels; there is too much to learn. These cause anxiety and may make the child nervous. Performance pressures, technology, precocity, media influences, etc. are some of the other factors that add to the stress in childhood. Signs Watch out for subtle changes in moods and behaviour. With adults, it is easier to identify the stress and hence rectify it. But with children, it is quite a challenge. Most of the children are themselves unaware of the stress they are facing, they don't understand why they are feeling sad or angry or fearful. They are just not at ease. Inordinate crying or screaming is a common sign. Being withdrawn, aloof and quiet is another way by which kids express their tensions. Physical signs can be seen in basic physiological changes - in sleep patterns (oversleeping or inability to sleep), eating habits (not eating or eating too much), frequent aches and pains, especially digestion disturbances and headaches, etc. Managing childhood stress Pay attention to your child. Listen to what he/she is saying, but also try to listen to what he/she is not saying in words, although only in action. Help the kids open up to you, spend quality time with them and talk to them about everything under the sun. Be well connected with their school teachers and parents of their closest friends. If the need be, please don't hesitate to reach out and seek professional help from psychologists and child counsellors. "One of the luckiest things that can happen to you in life is, I think, to have a happy childhood." - Agatha Christie  
Faking illnesses - An illness in itself?In 2008, a 28 years old woman in the US shared some shocking news with her friends. She had been detected with cancer. She posted updates on social networking sites and wrote blogs on her illness. Sympathy poured in from all corners. Some even sent in monetary help to cover her expenses. The saddest part of the incident though was not her cancer; it was the fact that she had faked it! Police investigations revealed her little trick when no evidences or records were found at the hospitals! Apparently, this isn't a unique case;  faking illnesses or malingering is a very common occurrence. All of us have done it at some point in our lives. While we may have done it to escape a school punishment or to take undue advantage of the office 'sick leaves' for personal purposes, it is usually done on a harmless level. But faking illness can be a chronic disorder too and  medical professionals even have a name for it-; Munchausen's Syndrome. People suffering from this syndrome fake illnesses that they don't actually have, to gain sympathy or simply to be the center of attention. Usually gaining sympathy is the main reason why people fake illnesses. It gives them a chance to be in the spotlight. Everyone calls and visits, expresses concern and fusses over them. Lots of love is showered upon them. Another common reason for faking illnesses, is money and at times, the monetary benefits are higher than the emotional ones. No one hesitates to fulfill the last wish of a dying person, however expensive it may be. Often there are mixed motivations and the person faking an illness has many reasons to keep up the pretense of being sick, for as long as possible. Some people really do have a disease — a mental illness known as a factitious disorder. People with this disorder pretend to have an illness, which is usually a terminal one and often go to great lengths to maintain their hoax. Munchausen syndrome by proxy, is another form of faking illness. People with this disorder, fake illnesses of people under their care; and they usually do this, for monetary benefits. Children are the most common victims in this disease. When you tell someone that your child has cancer, you will receive a great amount of sympathy and all the money you want, no questions asked! People with these disorders are extremely cunning. They go to great extents to maintain their lies. They will build grand stories, complain of fake pains and aches, get admitted to hospitals and undergo a battery of tests, numerous times. Interestingly, they never allow and frequently discourage medical professionals, from talking to any of their family members. Since they know they are faking the illness, they will refuse to undergo treatment, for obvious reasons. . If you think a loved one may be exaggerating or faking their health issues, attempt a gentle conversation, voicing your concerns. Avoid anger, judgment or confrontation, while offering support and care and if possible, help them in finding a treatment. Treatment includes empathy, helping in identifying feelings and issues that led to the development of the disorder and finding  alternative healthy ways to deal with those feelings and issues.
Beating the weight loss plateauThere comes a stage when you stop losing any weight in spite of strict exercise and diet regimen. This is called as weight loss plateau. When calorie intake is reduced along with exercise, the energy required is obtained from stored fat which eventually leads to weight loss. This rate of weight loss slows down and eventually stops once body reaches its set point of metabolism. This set point varies from person to person. So what can you do next? Here are some easy ways to get the weighing scale budging: Modify diet pattern: Metabolism slows down with lowering calorie intake. To reset metabolism, you need to have an adequate amount of calories. This can be done by including fruits and vegetables, whole grains, and proteins in diet. More energy is needed to burn proteins than carbohydrates or fats. Eat within half an hour or hour after exercising. Add proteins and carbohydrates to diet. Sip water: Increase total water intake in a day. Drink water before, during and after exercise and throughout the day. Change the workout: Change the exercises you do daily. Muscles get accustomed to a routine workout. Switching exercises and continually challenging helps burn more fat and build lean tissue. Change the type and time or duration of exercise. Try cycling instead of running if you have been doing it for long. Running, swimming, dancing, and Pilates too are good options. Skipping and brisk walking help in burning calories too and break the plateau. In the gym, change the exercise or number of repetitions. If you have been working on machines for long, try weight training or floor exercises. Take rest: Adequate rest is essential for the body to rejuvenate. Muscles, tendons, and ligaments get slight internal and external injuries which can be healed by rest. Proper rest helps repair and regenerate the tissue and makes them strong. Make these changes and get the needle on that weighing scale to budge.
10 Makeup myths bustedMyth 1: You do not need Primers if you have evenly applied foundation and moisturized your skin well. Fact: Primers are basically used to fill your fine lines, reduce the visibility of your pores and keep your foundation looking fresh and radiant, for longer. With age, your skin develops its natural flaws and the use of primers becomes mandatory. For best results, use your primer after moisturizing your facial skin and before applying your foundation. Myth 2: Red Lipstick does not look good on everyone. Fact: Generally, red can look good on everyone. The trick is to find the right shade of red that suits  your particular skin tone. However, to play it safe you may start using red lip colors with blue undertones, as they look good almost on everyone. But remember, learning to apply lipstick the right way, is just as important for the right effect. With just a little patience and practice, you can surely achieve those red hot lips, you've always dreamt of. Myth 3: Foundation should match your cheek, hand, neck or forehead. Fact: Getting the perfect shade of foundation is one of the toughest tasks, while choosing your makeup products. Your facial skin is much lighter than your hands; yet at the same time, it's a tad bit darker on the sides and forehead. Hence, the best way to select a foundation is to check the stripes on your jawline. But, always remember to step out into the natural light while making this crucial decision. Myth 4: You can change the lip-size using lip plumper. Fact: Ok Ladies, a lip plumper will definitely not change the size of your lips. The way they work is that they give your lips a swollen appearance, by stimulating the blood flow and irritating the lips. The main ingredients in a lip plumper are hot pepper, menthol, caffeine and cinnamon which results in the temporary pronounced pout, which soon wears off. Myth 5: Pumping the Mascara eliminates Clumps. Fact: If you pump your mascara tube, you're actually pumping in more air, due to which the mascara solution dries out quickly and allows germs to breed in your mascara. The best way to eliminate clumps is to rotate the brush inside the mascara tube and then wipe it down with a tissue, before application. Myth 6: Never wear an eye shadow matching the color of your eyes. Fact: It is true that if you use contrasting colors, your eyes will pop and look bolder. However, this does not mean that if you have brown eyes, you avoid your favorite brown eye shadow. Myth 7: Choose a concealer that is lighter than the foundation. Fact: Every woman has a different skin tone and depending upon your skin tone, you might need more or less, foundation coverage. So, it is always better to choose a concealer that comes closest to the shade of your foundation. Myth 8: Always choose a foundation that is lighter in color compared to your skin tone. Fact: If you choose a shade of foundation lighter than your skin tone, after a while your face will start showing two different skin shades. Always, test the foundation on your jaw line and if it blends in seamlessly with your skin tone, that's definitely the right shade for you. Myth 9:  Makeup leads to acne. Fact: No research, until date, has conclusively proved that makeup causes acne. Poor hygiene, sleeping with your makeup on, not cleaning your makeup brushes regularly, and using the products beyond their date of expiry is what leads to breakouts on the skin. New products may also cause skin irritation; which is why, it is better to test them on your elbow, before using them directly on your facial skin. Myth 10: Tingling makeup products are perfectly fine. Fact: Makeup products that make your skin tingle are sure to damage your skin and cause injury. It may also lead to bacterial infections and pimples, so you should certainly avoid such products. You should never compromise on the quality of makeup products, or else your skin may have to suffer the side effects.
A guide to earwax impactionBiologically, the earwax which builds up over time moves through the ear canal from movement caused by chewing or other jaw motions. It is also extricated through the inside-out motion of the skin of the ear canal - it reaches the outer ear and peels away. The cerumen is produced in the outer regions of the ear and not in the inner recesses. Earwax impaction refers to the condition where the ear wax builds up to such an extent or in such a manner that it causes discomfort to the entire body. In many cases, earwax impaction occurs when patients use cotton swabs or safety pins to clean their ears, only causing the wax to drop deeper into the ears. The main symptoms of earwax impaction include difficulty in hearing, faintness, ache in the ear, foul smell in the ear region, ringing or sound in the ear (also known as tinnitus), a sensation of fullness in the ear, and lastly, discharge from the affected ear. The most vulnerable groups for this condition include those who use hearing aids or ear plugs, elderly people, and those who insert cotton swabs or other items into their ears, as well as those who have an odd ear shape which could negatively affect the discharge of the earwax and those suffering from development incapacities. Did you know that one of the most common methods used by people to clear excessive earwax is ear candling where a candle (in shape of a cone) is placed inside the ear canal and set alight to warm up and remove the wax? This is one of the most dangerous methods causing burns, worsened blocks, and damaged eardrums; this should be clearly avoided. The diagnosis of this condition can be done by an ear specialist using an instrument called otoscope. Earwax impaction is treated in many ways. While at home, you could try to clean the outer region of the ear by wiping with a cloth, the physician could irrigate or syringe the ear to wash out the ear canal with saline. This procedure is generally done once the wax has been softened by the use of cerumenolytic solutions aimed at dissolving the wax like mineral oil, peroxide-based ear drops, and hydrogen peroxide. Physicians also use special instruments to remove the built-up earwax like forceps, cerumen spoon, and suction tool. The best way to prevent cerumen impaction is by not inserting anything into the ears to clean it up. Cotton swabs should only be used in the outer part of the ear. In case you feel that the buildup is regular, then you can fix an annual appointment with your physician for cerumen removal.
Flash the pearliesRemember the lines from the song, Words? Smile an everlasting smile, a smile can bring you near to me.  Well, ideally, you wouldn't want your teeth to be yellow when you flash that smile. So for those who have shades of yellow on their teeth, here's how you can go back to white. It's first important to understand what causes yellowing of the teeth. Eating habits: Carbonated drinks dissolve teeth enamel. Tea, coffee and other caffeinated drink stain the teeth yellow.In addition, alcohol and cigarette smoking too can stain teeth. Tobacco chewing especially produces stains that are difficult to remove.Food rich in artificial sweeteners are harmful for teeth. They not only make the teeth yellow but also produce cavities. Chocolates, pastries, ice-creams and all such sugar-rich foods are sticky. They stick to teeth and have corroding effect on tooth enamel and dentin and cause yellow teeth, decay and toothache. Oral hygiene: Poor hygiene of oral cavity leads to stains and caries. Take good care of your teeth. Brush teeth twice. Floss them and use a mouthwash. Ageing: Gradual loss of enamel and wear and tear lead to yellow teeth. Medicines: Medicines like iron tablets, tetracycline too can lead to yellow teeth. Injury: Trauma to teeth can sometimes lead to yellowing. This is common amongst kids. Preventing yellowing of teeth Maintain a good dental hygiene. Brush twice for atleast 3-4 minutes. But be gentle while brushing teeth. Gargle every time after you eat.This removes the leftover food particles and keeps the teeth clean. Avoid use of local powders or corrosive substances. They damage enamel. Fruits like apple, cucumber, and carrot act like cleansing agents and keep teeth clean. Fruits like sweet lime are rich in vitamin C and help to keep gums and teeth healthy.
Smoking causes impotence!Men who smoke heavily are twice as likely to suffer from impotence or erectile dysfunction. The link between smoking and ED has been established beyond reasonable doubt. Smoking causes a hardening of the arteries or blood vessels. For a penis to grow erect or tumescent there has to be a healthy blood supply. Now imagine the cross-section of a smoker's penis where there are plenty of blockages and hardening of the blood vessels. Can the penis then grow erect with so many hindrances to the blood? There is also an acute loss of sensitivity to the penis which is a direct contribution of smoking! Previously, alcohol was a hot favorite of the medical lobby when it came to 'impotence.' Wish smokers could say the same thing about moderate smoking! Even moderate smoking can make an existing condition of impotence worse. One could make changes to one's lifestyle and diet and curb stress to treat ED (erectile dysfunction), but all these will come to naught unless one really resolves to give up smoking permanently. Just within a few hours of kicking the butt, the body starts to repair itself. Of course, it may take longer for the blood vessels to actually undo the blockages and have a free run for the penis, but it will certainly happen, slowly and surely. Smokers may have an underlying condition of anxiety, which is made worse by nicotine, which in turn causes performance anxiety, not greatly helped by blocked blood arteries. So smoking not just makes you physically impotent, but also mentally impotent too. It is a powerful narcotic which is hateful to the body and spiteful to its salubrity. Please enroll into a 'stop smoking now' campaign with the help of friends or family. Check for any 'nicotine anonymous' programs in your neighborhood or just do it all by yourself. Otherwise, the only thing hard about your penis will be hardened arteries and lots of hard luck!
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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