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Health check up checklist for men Prostate Cancer - Prostate cancer is the lesser known killer in men. It is a slow growing cancer, but at times, its symptoms can be aggressive as well. Detecting prostate cancer at its onset can help in treating it effectively. Tests include a digital rectal exam and a blood test for Prostate Specific Antigens (PSA). Testicular Cancer - This uncommon cancer can affect any male between the ages 21 to 55. A physical exam during yearly medical checkups is recommended for all men. Men having a higher risk, with family history, should speak to their doctors regarding additional tests for screening. Self-examination through regular gentle palpation of the testicles to notice any change in shape or size, presence of lumps is also suggested by doctors. Colorectal Cancer - This is the second most common cancer in men. Men over 50 and younger, if they have a familial risk, are suggested to get a screening colonoscopy done to detect this cancer. It usually starts as a polyp that grows and invades the nearby areas to develop into a full-blown cancer. The polyps, if detected early, can be removed and cancer prevented. A CT scan or a double barium enema can also help in detecting polyps. High Blood Pressure - With the kind of lifestyle men lead today, almost every other man is bound to have BP issues. Regularly checking the BP is essential as it helps detect high BP which may lead to a variety of other problems including stroke and heart attacks. The sooner the detection, the sooner the measures for control. Cholesterol Levels - Bad eating habits, sedentary lifestyle, and mental stress can all lead to lots of cholesterol roaming around in your arteries. This will eventually clog the arteries and cause diseases like high blood pressure and atherosclerosis which can be life-threatening. Get your total cholesterol, LDL, VLDL, HDL, and triglyceride levels checked regularly and initiate timely interventions to bring them under control. HIV - This is the most commonly spreading STD among men. Due to its chronic nature, HIV is often detected accidentally when it may be too late. Regular tests for HIV detection are essential if one is physically active with multiple partners. Be safe though and use a condom. Glaucoma - It is extremely common and is one of the leading causes of blindness. Glaucoma has no cure, but it can be controlled well with timely detection. Screening tests should be undertaken by men under 40 years at an interval of 2 to 3 years after 35. A yearly test is recommended for older men.
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.
Perfect partners in crime - Midlife crisis and dementiaThe responses we have to common stressful events in our daily lives have a lasting impact on our brain structure. The effects of a stressful event last a very long time, though apparently we seem to have recovered from it. Researchers say that the stress hormones keep circulating in our body long after the stress has passed. According to a recent Swedish research study, our response to common life events may trigger long-lasting physiological changes in the brain. These interestingly shocking findings come from the Prospective Population Study of Women in Gothenburg, a long term study on 800 women that lasted for almost forty years. The women who were a part of this study were all born before 1930, and underwent regular neuropsychiatric tests. The study started in 1968 assessed women for any baseline stressors like workplace problems, widowhood, alcoholism and illness in the family. Women who had serious issues at the start of the study had a 21% higher risk of developing Alzheimer's Disease and 15% higher risk of developing dementia later on in life. Interestingly, having to take care of a mentally ill family member like a sibling or mother, was found to be a major cause for development of dementia later on in life. The findings of this study show that accumulated stress from common life events has severe physiological and psychological consequences. These physiological consequences include adverse effects on the central nervous, cardiovascular and endocrine and immune systems. There have been several studies that state that the effects of stressful events like earthquakes, cyclones and floods can have a lasting impact on life and often shape the person's personality. What makes this study interesting is its finding that daily stressors accumulated over a period of time and often left unresolved, have a lasting impact that shows up in later stages of life!
Exercise to fight off depression in school kidsBefore concluding on the effects of different forms of exercise on children, it is important to note the distinction between fitness and exercise. Fitness encompasses most importantly a healthy lifestyle of which exercise forms a part. For this reason, when researchers examined the impact of fitness on emotional being of a child, most of them covered three main determining factors, namely the body mass index, the child's feeling about fitness, and a shuttle-run test. Depression is characterized by recurrent feelings of despair and hopelessness. The main symptoms of depression include sensations of unworthiness, dysfunctional thinking, lack of concentration, low level of sleep, anger, social isolation, crying, physical grievances like headaches which do not react to treatments, reduced interest in social activities, and thoughts on suicide. It is not necessary that every child will undergo all the symptoms. If most of the symptoms recur continuously, then it is a warning sign. The propensity towards chronic depression is higher in those who suffer from depression during childhood. A healthy lifestyle is accompanied by a range of psychological benefits. When you exercise, your body produces endorphins which stimulate positive sensations about the self. Produced by the brain, they also reduce the sensation of pain. A healthy lifestyle boosts the sleep cycle and helps in coping better with tough situations. A medical study conducted by University of Texas revealed the positive effects of physical activity on middle-school graders. It was found that there is a robust link between depression and fitness in girls. Even though boys show association, it is not explicit.  Conclusively, it was pronounced that exercise helps in reducing the chances of depression in school-going children. The best way to help your child is by introducing activities that she or he finds interesting. Initially, you might face resistance. The most important task is to communicate with your child. In the face of such resistance, you can attempt to find a hybrid therapy to reach out to your child. Apart from scheduling appointment with a child psychologist, you can also meet up with a physical health advisor. Emphasize on activities which will also help your child to meet new people. According to the Center for Disease Control and Prevention, one of the main benefits of physical activity is betterment of academic achievement and conduct in children.
CryophobiaCold or hot can be a very subjective term as every person's tolerance for either heat or cold can vary. When some of us react in an extreme manner to all things cold, then it could be a case of cryophobia - the fear of catching cold or the fear of cold weather. Derived from the Greek "kryos" + phobos gives us cryophobia, which is a mental aberration where the mind develops a nagging and persistent fear of all things cold - be it cold weather, ice-cream, or maybe even a cold shoulder! Jokes apart, a person suffering from this condition could really experience 'hot weather' in his relationships as he will completely avoid any contact with anything cold. If the weather is a bit nippy then that's a veritable disaster for Mr. 'Avoid De Cold' as he will do everything in his power to stay indoors, for instance - turn on the central heating and wrap himself up until the mercury rises to an agreeable level. Though it is decidedly different from your run-of-the mill phobias, cryophobia could be of various types. There are some who are only afraid of cold in the 'weather' sense and are otherwise cool about touching cold objects or even having an ice-cream. While there are some who would probably break out into, if you will excuse the term, 'cold sweat,' even while watching floating icebergs on a Nat-Geo documentary. So, the sensation of cold is quite subjective, and hence the various strains of cryophobia. Generally, this fear would manifest quite logically for those who have occasioned to be trapped under ice accidently or maybe those who have suffered frost bite from exposure to cold weather during a skiing holiday. Under such circumstances, avoidance, though irrational, could be perfectly logical. If you monitor weather reports constantly and experience discomfort even in moderate climates, then you should get yourself checked for cryophobia, as chances are that soon you will be restricting yourself indoors and cutting yourself off from the rest of the world. Some people might just overcome fear or anxiety by wearing an extra layer of the woolens or turning up the central heating. For deep seated fears, it may require long-term counseling or medication. Some people might just have this morbid fear of developing pneumonia from a common cold and hence may take elaborate measures to avoid going out during cold days. This too can be quite normal since most of us don't want to call a day off from work due to a nasty cold. But despite adequate protection if you are still afraid of venturing out to work or are avoiding social contact just because of an irrational fear of catching cold when the weather outside is made for the beach and you are in the middle of summer! Then the catchphrase is - You have cryophobia!
How to remember everyone you meet?Now that would be quite a feat, would it not? To be able to recall the name and occupation of every person we ever encountered right down to the minutiae of how, where, and why we were introduced to them to begin with! Sometimes we raise the bar of forgetfulness to the extent of forgetting just who it was who introduced us to "Mr. what's-his-face!" If only there were ways to remember the modest and average people who leave virtually no impression on us, wouldn't that save us great embarrassment? Plus it will help us do away with those sheepish looks when it dawns upon the other person that you haven't the foggiest of notions as to who he is. Stranger: Hi! You remember me? How are you doing, Frankie? Frank: Umm! I am well (this guy's face looks mighty familiar, but for the life of me, I cannot recall ever having cast my eyes on him). Stranger: So, how was your annual bridge completion? Manage to beat the Swiss pairs this time? Frank: Atta boy! Got it! This guy happened to be kibitzing at the weekend bridge club at Aldermere. Whew! Stranger: You gave me quite a start there. You looked right through me and I was quite not pleased at the fact that just last week I happened to congratulate you. Frank: Well Martin, be tough to not remember you, of course I do! Just didn't think of bumping into you here. Martin: Well, I am Walther and I can now see that you don't remember me at all! How many times has the above scenario happened to us? While it is well-nigh impossible to remember every name or face that we come across, it would be  a good habit to at least attempt our 'mental name book' to avoid an occasion for future embarrassment! Now, how in the world does one do that? Simplest way would be to carry a small notebook with a pen to make note of someone that you have just been introduced to, at a meeting or a social do. Our friends often introduce us to people and chances are that if there is no occasion to remember that person, then the brain fades it out of its memory list, as it will only use up space on the brain's 'hard disk.' Human memory might be jogged to remember trivia from 25 years ago in great detail, but ask a simple question - remember what you had for lunch last Tuesday?  - and that would be very difficult to answer, especially if last Tuesday was just an ordinary day with no special reference points around lunchtime to help you remember. Maybe if something momentous had occurred on Tuesday last, like pretty Meg from next door, sharing lunch with you rather unexpectedly, then you can bet your bottom dollar you will remember what you had on the day in question. So create reference points! When you are introduced to someone, first and foremost, reference it with who introduced you and then try and make a reference of at least one unique distinguishing feature in that person. Now you don't really require the eye of a physiognomist, and it would be mighty impolite to stare hard for the "distinguishing feature" coin to drop. So a quick look and you got 'long nose Mary Gomez' all referenced and ready for recall at the next chance meeting. Make the reference phrases funny so that you won't have any problem whatsoever in recalling the name behind the funny phrase when you most require it. Alternatively, try associating a picture with the name if you aren't very good with phrase reminders. These techniques are called mnemonics, which is pronounced ni-mon-nics, and funnily enough the very curious spelling - Mnemonics makes you want to have a picture card memory association for the right pronunciation. A mnemonic for this could be 'knee-moan- knicks". Easy enough, i.e., if you remember the sequence right. You could also try memory exercises with names picked off from the telephone directory at random. Pick an A-lister say - 'Anderson' and then flick through to D and pick 'Dougherty' and so on until you have picked at least 10 names of a different alphabet. Now, try and write down the numbers that you must have undoubtedly memorized until now. You can consider yourself blessed even if you are able to memorize the number of the third person by the time you reach person number 10. This will give you a memory for names and numbers at least. Or, go through any university web sites and look at the photo galleries of past alumni. Give yourself 1 minute to quickly glance at all the names on the page. Then try and recall the name by applying the memory picture association or develop your own technique. With regular practice, you could well be in the employ of the local police to help identify criminals off a line up. If that's too dangerous for you, then at least that will  keep your brain alert and active with this brain gym and help avoid any boo-boos in the future.
10 best and worst appetizersWhen you are munching on appetizers before your meal, the idea is to eat something that can trigger off the production of your digestive juices in the intestine, so that what you eat next, the food is easily digested. However sometimes, the appetizers are much more complex and heavier on your tummy and can actually reduce the metabolic activity and imbalance the digestion process. Here are some of the best and worst appetizers that are commonly served: Best Appetizers Vegetable Kababs: These highly nutritious and low calorie appetizers are a good alternative to fried items. Grilled vegetables or kababs are prepared by skewering red and green bell peppers, onions, tomatoes, mushrooms and zucchinis. To add to the taste, you may brush over some low-fat herbs and even garlic marinade. Two delicious vegetable kababs, will get you only 75 calories. Crab Cakes: Seafood offers you high nutrition and the best way to include the properties of seafood in your diet, is by choosing crab cakes as appetizers since these offer only 20gms of fat and 300 calories, while providing you with a high level of sodium (960mg). Spinach Salad: The best thing about good appetizers is that they are low calorie foods and provide great flavor and satisfaction while eating. One such fulfilling appetizer, is spinach salad. You can also use other green leafy vegetables to add more nutrition to the recipe. If you eat this appetizer before your meal, chances are, you will eat 10 to 15 percent less of the main course, which is certainly a great way to cut down on the calories. A cupful of fresh salad gives you only 80 calories. Beef Skewers: If you are in the mood to pamper your taste buds, but still want to stick to eating healthy, then beef skewers is the right option for you, in the appetizers section. These are usually served with peanut sauce in restaurants. You can opt for lean beef along with soy, garlic, hoisin, onions and barbeque sauce to make this dish yourself. Quarter to the pound is the recommended serving, which consists of 5 gms of fat, 130 calories and a high sodium content of 803 mg. Stuffed Mushrooms: Potato skins are a common appetizer people go in for, but these add more calories. Instead, you should opt for stuffed mushrooms that are way more delicious. The caps of mushrooms are stuffed with breadcrumbs and the cheese of your choice; and they provide only 50 calories per cup. This means that even if you eat six stuffed mushrooms, you are still within the limit of 300 calories. The worst appetizers are deceptive yet tempting in their looks and taste. But you should always keep a check on the ingredients before gorging on them, for your own benefit. Worst Appetizers Onion Blossom: Fried onions are certainly bad for your waistline. It is always better to eat a starter stuffed with more vegetables, instead of fried things. A restaurant preparation of onion blossom consists of 161 gms of fat, 1,049 calories and around 4100 mg sodium, which is more than double the limit required by an adult, making this appetizer a completely unhealthy choice. Cheese Fries: Cheese fries are one of the worst appetizers; these can be even more overwhelming than your meal itself, which is why health experts advise not to include this appetizer in any type of menu. Sometimes cheese fries actually come with more melted cheese on top, which is obviously worse. Spinach Artichoke Dip: Although this starter starts with the word 'Spinach', it is in no way a healthy appetizer. One dip of spinach contains loads of calories-1600, fat-100 g and 2500 mg sodium. It is certainly not the spinach but the cream base that is rich in saturated fat. Potato Skins: Potato skins have all the high calorie foods such as meats, sour cream and cheese. When you take one pop of these, you will be adding 150 calories, which is quite a big number. Moreover, these appetizers are not filling. A plateful of potato skins adds 1,340 calories, 1,850 mg sodium and 94 gm fat and yet leaves you hungy. Cheeseburger Skins: Although these appetizers look small, there are loads of calories packed in them. One order of Cheeseburger skins can total up to 1270 calories, with an added 2310 mg sodium and 82 gm of fat.
Bile block - Understanding gallbladder problemsRavi was a young intern working the night shifts in a government hospital when he was asked to examine a patient who had just been brought in. The patient was a 45-year-old, a fat man, who was complaining of pain in the right side of the abdomen along with nausea and vomiting. On inquiry it was revealed that he had eaten a very heavy fat-laden dinner. Remembering what his surgery professor had taught him about cholelithiaisis, Ravi immediately guessed what the diagnosis could be. He, however, sent the patient for a blood test and an abdominal scan. The reports confirmed Ravi’s suspicions- cholelithiasis, gallstones. The gallbladder is a tiny pear shaped organ that lies just below the liver. It is responsible for storing the bile that is produced by the liver for digesting food. It ensures the smooth outflow of the bile from the bile ducts. When the bile components aggregate in the gallbladder, they build up to form gallstones, similar to kidney stones. The gallstones are usually small enough to pass on to the intestines and be eliminated without causing too much trouble. At times, these stones may be big enough to block the outflow of the bile and give rise to a variety of symptoms depending on the size of the stone and severity of the block. The symptoms include -  Intermittent colic. A bloated sensation with constant nausea. Inability to tolerate fats. Vomiting.  Fever with chills if the stone becomes infected. Gall stones though found in both sexes, is more common in females. The risk factors for developing gallstones include - Diabetes. Organ transplant. Diseases like hemolytic anemia, sickle cell anemia. Liver cirrhosis. Failure of the gallbladder to empty properly, e.g., during pregnancy. Rapid weight and nutrition loss due to any reason. Gallstones are confirmed by a blood test to check the liver function and by an abdominal scan. Medications to dissolve the stones, and surgery in case of large stones that do not dissolve with medications, are the treatment options.
How to communicate with a patient who has a strokeThe first and the most important thing to communicate with the patient, is to give undivided attention. Give attention to his activities, gestures, his facial expressions through which he may try to communicate so his feelings could be understood. Eye contact is also important but the patient having stroke may look at you square in the eyes but he may not respond to your conversation. While communicating with the patient you should always stand in front and tune out all the other sights and sounds in the room. Maintain full silence around the patient in the room, turn down the volume of the television, radio and ask other people in the room to be silent. You may communicate with the patient by making contact by touching the hand, chin, cheek or areas which are not affected by stroke. As the side which is affected by stroke, does not have any sensations. You may communicate with the patient through his family member by telling the family member to communicate with patient by saying, "Look at my face"; through this we can gain the patient's concentration. You should always speak clearly with the patient in a normal soft volume. Express your ideas in simple terms, form simple sentences, do not use complex words. You may repeat the sentences or an important term again. For example to ask if the patient wants tea, repeat the word 'tea'. More complex thoughts can also be similarly conveyed and repeated. You may also use hand gestures with clarification like doing Hello by waving your hand or through your hand action, you may ask questions like, How are you? Are you ok? What do you want? Through this both caregiver and stroke patient can benefit. You may ask your patient to point out whatever he wants or if he needs anything. And gradually he will develop the habit of pointing the daily items like television, newspaper, remote, eyeglasses radio, drapes an uncomfortable foot, the patient can indicate any pain or headache. Through this communication we can make the patient learn, use mechanical lifts to get in and out of the bed, and with the help of the attendant by demonstrating the patient how to use it. Sometimes when the communication does not work, take a break, give it time and try again, do not get frustrated and reassure the patient that yes, he or she can do it. Good communication with the patient is very important as they cannot speak their basic wants and needs clearly. The patients suffered a stroke also have slurred speech. There is a deviation of the angle of mouth. They are mostly bed ridden and could not carry out the routine activities.
Sex after 40Sexual changes in normal aging after 40: Erection takes longer time Require manual stimulation, particularly by partner Erection may subside during foreplay or coitus Decreased frequency of nocturnal erection Pre-ejaculatory fluid decrease or absent Ejaculation less forceful Seminal fluid volume decreases or absent Frequency of desire for sexual release decreases with age. Aged couples learn to cope with their own sexuality. Some are happy with foreplay and self masturbation, others insist on more usually it is the male. Frequency of sexual intercourse between 20-95 years : Sexual intercourse decreases with age as the study shows. Decreased during 5year interval after 34 years Weekly frequency: 30 - 34 years 2.2%; 60 - 64 years 0.7%; 65  - 74 years 0.4%; 75 - 79 years 0.3% Do we need to change this pattern with Viagra? I would say yes - sex can be  joyful till the last days. Nobody needs to be impotent now. Home devices like rubber bands, ribbons are also used to hold the blood back in the penis when the erection is not adequate. Vacuum pump to draw blood into penis with an application of a ring after erection is also found suitable by some. Active intervention by drugs (both allopathy, ayurvedic and unani) have been successfully developed. They may be applied topically (minidoxil), inhaled (amyl nitrate) inserted into the urethral passage, injected into the corpus cavernosa or taken orally (Sildenafil, Tadalafil, etc.). Finally if all fails silastic rods can be implanted in the penis to give permanent erection. The joy of living lasts a life time.
Is sex linked to self esteem?Man is a curious creature, full of quirks and contradictions. Sexual intercourse, something that most people consider an intimate and private experience, is spoken about in hushed tones and often, with some discomfort. We don't reveal or talk about our sexual desires, as readily we discuss our salary packages or food habits. This is quite ironic seeing how sex is an important gauge for a person's self esteem and also an indicator of his/her social desirability. The very thing that we do under covers, we somehow choose to "keep under cover". The Link between Sex and Self Esteem: Self esteem is an important factor that determines the mental & physical well-being of an individual. All of us have a craving to be understood, liked and appreciated; and these form the equivalent of our basic needs on the inverted pyramid- Food, clothing and shelter. For a human being to flourish and prosper, consumable food, without the mental food of appreciation, is not enough; and sexual intercourse or an intimacy with the opposite sex, is one way of validating that need. Sex therefore, ceases to be just a physical need instilled by nature for the perpetuation of the species, but goes into the larger emotional cum psychological dimension of self actualization and realization. Though some of us might be embarrassed to broach the topic of 'whether or not we are getting enough', the truth is that every human seeks to achieve his sexual potential, even while he or she might, not be aware of it. Most of us have the ability to get the foods matching our taste preferences onto our plates, but with sex, this could be a little difficult, since sex, is a complex subject with a lot of social, moral and religious links. The truth is evident in the number of marriages (the very cornerstones of civil society) that fail on the basis of sexual compatibility, either by setting unrealistic sexual expectations or by not owning up to, or even identifying, one's sexual needs. This has repercussions on the psyche and self-esteem of a person, and this is especially true in the case of men in particular, as they may feel completely inferior for not being able to attract a sexual partner matching his desires. In some people, this also leads to a case of self-loathing, for having sexual needs which a partner doesn't understand, or much worse, needs which are considered taboo and sinful (Homosexuality, Anal Sex, Group Sex, Fetishes, etc.) These complex emotions can wreak  havoc on a person's self-esteem, by creating severe internal conflicts and serious self-doubts. Now socially, sex can either liberate a person, or hold him prisoner. At times, the unfulfilled needs may get repressed and banished to the shadows, only to be played out later, in the form of sexual adventurism and crime. Just one look at the sexual crimes in our society today, and we can clearly understand just how healthy our collective self esteem is! The very society that frowns upon prostitution, is actually responsible for creating it, though everybody would like to pretend otherwise. The crux of the matter is that "sex" and "self esteem" are closely related; and one should not shy away from addressing any issues one might face regarding one's sexuality. Physical love is necessary for the survival of a relationship and one needs to make time and efforts to successfully create one's own sexual space. The positive effects of a good sex life can be seen in an increased work productivity, fewer illnesses and an increase in one's overall efficiency. Some people are haunted by sexual guilt and confusion and when they keep it all locked up, they suffer from unexplained physical pains and feel 'down in the dumps' mentally. Another problem with appreciation from the opposite sex, is the addiction to  external validation. Some people feel utterly worthless until they receive positive feedback about their looks or abilities on a regular basis. This can be downright devastating, as in these cases, there is a great dependence on external factors for one to feel good. While no one denies the "feel good factor" of sexual appreciation, it is up to each one of us, to decide just how much of control one must be giving to external factors, to determine our personal self-esteem. The appreciation may be theirs, but the esteem is entirely of the self and only the self can decide how much of appreciation and sex is enough.
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