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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.
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.
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!
A baby - proofed guide to childcareCaring for kids is an important task. Everyone wishes to nourish kids in a loving and caring yet protective atmosphere. Initial stages of development call for more care and attention. Health, hygiene and safety at home and outside are important when it comes to kids. Here are a few helpful tips to all the parents: Nurture your infants with massage. Learn a right way or get it done from a professional. It is a great therapy to make muscles strong and bond with the baby. Prolonged crying bothers parents a lot. Usually continuous crying for long hours is suggestive of colic or stomach ache. It is the most common problem in kids, the reason being immature gastric system. Do not panic. Keep medicines at hand and give them as per instructions by your kid's doctor. Toddlers often insist on being carried even when they know how to walk well. Make sure to hold them comfortably. Diapering a baby is a skill that must be mastered especially when the baby is fidgety. Holding baby in right position flat on the back simplifies the task. Parents adapt to doing the job effortlessly with practice. Transition period of swapping from breastfeed to bottle known as weaning is a tough task for most of the babies. Consider gentle weaning strategies advised by the doctors. Do not be abrupt. Go slow! Some Safety Tips: Cap and lock the medicines, detergents, chemicals etc. in containers keeping them far away from the children. Bathingwater should be always checked before bathing the baby. Do not leave kids alone near water tub or any water source alone. Avoid leaving baby in a highchair to prevent injuries such asbaby climbing out, falling, or sliding. Lock up all the knives, matches, and plastic bags away from children to prevent poisonings, bleeding injuries, burns and suffocation.
What is megalomania?Bertrand Russell's quote on megalomania perfectly describes the condition:"The megalomaniac differs from the narcissist by the fact that he wishes to be powerful rather than charming, and seeks to be feared rather than loved. To this type belong many lunatics and most of the great men of history." Megalomania is a delusional bipolar disorder. The sufferer believes he is an all-powerful person and that he is superior to all other people. Megalomania comes from the Greek words megalo which means large or great and mania which means madness. It is a psychopathological disorder that has delusional fantasies of power, exaggerated self esteem and a sense of omnipotence. The sufferer may believe he is God or some famous athlete. Although megalomania is a term used for power hungry people, it is clinically described under the mental disorder of narcissism. Narcissism is self-love. Though self-love is a healthy concept, narcissism is a pathological state where one loves oneself to the extent that he starts despising others. Megalomania is caused by certain phobias and mental conditions associated with emotions and personality. In everyday life, megalomania can be a person's mental way of reacting to frustration, abandonment or some serious loss. In the social world, the term megalomaniac is often synonymous with control freaks, power-drunk army generals, executives and politicians. The treatment of megalomania includes medications. The challenge here is that the person may not believe he has anything wrong with him. He, in fact, believes that he is so great that no harm can come to him, so talking him into getting himself treated is very difficult. Adolf Hitler, the German dictator, was a power-hungry control freak. He believed that he was the supreme commander and that his race was the only race suited to inhabit earth. All other races, especially Jews, were inferior and had to be wiped off the face of the earth. Adolf Hitler was megalomaniac.
Top 10 tips for weight maintenanceTIP 1: Stay Calm and PlanDon't worry about your weight excessively. This will only result in stress which can be counter-productive to your pursuit. Remember that you have reached the goal you had to and you are strong enough to sustain it. Take one day at a time. Do not think about how you are going to keep it forever. Just focus on the next day. TIP 2: Health JournalKeep a journal where you note down your eating and exercising patterns. Write down what you eat, plan your meals, drink adequate water, and form an exercise regime. Did you know that you can include an activity within your life as a habit by performing it for 21 days? Do these things not because you have to but because they are good for your health. Slowly, they will become a part of who you are. TIP 3: Being Healthy Is A Lifetime DealOne of the greatest mistakes that people do is to think that once they have lost weight, they can return to their early eating habits. Remember that your health is with you for life. Shift your perspective from 'I have to become thin' to 'I have to be healthy.' Once you do this, you will find it easier to stay healthy for the well-being of your body. TIP 4: Be RealisticWhen you are planning your lifestyle, don't take up unrealistic goals. This is one of the reasons why weight-trainers say that the best way to reduce and sustain right weight is to make it 'your life.' Eat right, sleep well, and drink lots of water. These three, if done properly, can help you to have the right body weight. If you have any rules like 'don't eat cake or pastries ever,' 'quit drinking,' then rethink about them. Are you going to be able to never eat sweets? The primary goal is to make a balance, choose the middle path. TIP 5: Get An Idea Of Your Weight-PatternMany people stop weighing their body once they have reached the ideal weight. They think that the scales are only for the fat ones. A person with such a perspective is only looking for slim bodies and not healthy ones. Remember that your weight is not a judgment of your appearance, but a barometer of your health. So do not stop doing the weekly weight checks. Keep a report of your weight every week and check out the causes for any abnormal changes. TIP 6: Accept Your Limitations And Learn From ThemEveryone has their ups and downs. Don't get discouraged and be angry at yourself if you binged on a donut on a cloudy day. Everyone makes mistakes. It is not the end of your weight maintenance. It is simply a blip. Learn from it. Know what the causes are for it and work on making sure you react to the cause differently next time. TIP 7: Thirst And HungerYour body could confuse your thirst for hunger. So, if you are feeling hungry really soon after your previous meal, then start by drinking a glass of water and check if you feel better. If you do not, then it is time for a light healthy snack. TIP 8: Inspire YourselfWeight maintenance is primarily a psychological task. Till the time you were reaching the ideal weight, you learn everything you had to about being healthy. Now, you have to make sure you don't let obstructions stop you from sustaining this healthy lifestyle. So, join other people who are only in the process of maintaining their weight. Become part of the running blub or catch up with a health conscious friend regularly. TIP 9: Mind Over MatterBalance your eating patterns. If you think that you will be going out for lunch, then have a healthy breakfast and cut down on the dinner. You might be craving for a dessert, so you can have salad for the main course and treat your sweet tooth. Talk to yourself about what you are going to eat. Ask yourself if you really want to eat it because you are hungry or are there any other reasons for it. How would you feel about it after you are done eating? TIP 10: Celebrate Your AchievementsLastly, be proud of your weight maintenance program. Celebrate the fact that you worked hard towards making sure you have a healthy body and invite people who were part of your pursuit. Embrace your body and toast to the next year of a healthy lifestyle.
Muscle build up dietYou may think that you need fatty foods to bulk up, but this is not true. Fatty foods will do just that make you fat. Lean meats, fruits and vegetables will actually build muscle. Take a balanced diet of vegetables and lean meats to achieve your muscle building goals. Changing your diet to build muscle will help with your overall health. Eating food that helps build muscle will ensure that you are not wasting all that hard work you are doing in the gym. Workout utilizes considerable energy. Food is the only way to replace this energy. So what happens if you fail to eat the right type of food to build muscle mass? It will take longer to build muscle, and it may even prevent muscle building altogether once you reach a certain point. Is protein important or not? You bet it is. Protein provides the building blocks to build that muscle. What types of protein are best? Chicken, eggs, steak (with the fat cut off), fish, cheese (especially cottage cheese), and nuts are all great sources of protein. Finding out how much protein to eat when you are interested in building muscle fast is actually not difficult. First, you will need to find out your lean body mass weight in kilos, and then you simply multiply that figure by 2.75 to determine your daily protein requirement. Calculating your lean body mass uses some complex formulae, so ask a professional at the gym if you do not already have this figure. Carbohydrates, in moderation, are also essential when finding foods that build muscle. Do not eat too much, though, unless you choose high fibre carbohydrates, and then you can indulge in much larger amounts. High fibre carbs include rice, potatoes, oatmeal and bananas. Reducing fat in your diet is of course necessary to build bigger muscle on a body that appears lean and has a low body fat ratio. If you are focusing on what foods build muscle mass, you also need to bear in mind that it pays to reduce fat as well. Although proteins are essential, it is really important to select proteins that are low in fat, or that you can cut the fat off. So eat your chicken without the skin, and go for lean steaks rather than more fatty cuts of meat. Opting for cottage cheese or other reduced fat cheeses, and low fat milk also helps reduce your fat intake. You may argue that drinking has no effect on what to eat to build muscle. But you would be wrong. Hydration is critical to general health and wellbeing. Two litres of water a day is what most experts recommend for maintaining optimal health. To drink that amount, you need to drink up to 12 glasses of water a day, which is quite a lot. So start early in the day, and space your water consumption out throughout the day. Foods that build muscle are great and an essential component of your bodybuilding program. But do not be lulled into a false sense of security and think you can slow down on your workouts. Both bodybuilding exercises and bodybuilding diets are required to get a body to die for as quickly as you possibly can. Even if you are working on improving your physique slowly, you should combine a bodybuilding diet with bodybuilding workouts for best results. Sample Diet: 7:00am: Breakfast: 4 eggs + toast or oatmeal + milk with protein powder mixed in (a lot). 9:30am: Snack: 1 Meal replacement supplement + milk. 12:00: Lunch: Tuna sandwich (1 whole can) + green apple. 3:00pm: Snack:  2 Meal replacement supplement + milk. 5:30pm: Workout: Have water (or carb drink if you want), within 30 mins of end of workout (on workout days only) Meal replacement supplement + milk. (If you are going to have Creatine - put it in this Meal replacement supplement at the end of your workout). 8:30pm: Dinner: A chicken breast (aprox 8 oz + some rice or other starch carb + if you want also eat some veggies) Before Bed:  Meal replacement supplement + milk.
A quick guide to high blood pressureWhat is blood pressure? Blood pressure is the force or pressure exerted by blood on the walls of arteries while flowing through it. What is normal? A blood pressure value of 120/80 mm Hg is ideally said to be the normal. The upper value (systolic) reads the pressure when the heart beats (squeezes to pump the blood). The lower value (diastolic) computes pressure at rest in between the heartbeats when the heart refills with blood. What is hypertension or high blood pressure? The condition in which the pressure of blood in the arteries is persistently high.More the pressure, harder the heart has to work to pump the blood. The prolonged and too high blood pressure (BP) raises the heart's work persistently and can lead to grave damage to the arteries. This eventually leads to uncontrolled high blood pressure raising the risk of heart disease, stroke, and kidney disease in the long run.A blood pressure above 130/90 mm Hg is said to be high. What are the symptoms of hypertension? Hypertension can go unnoticed without any symptoms and thus remain untreated for years altogether. Thus, it is also called as silent killer sometimes. What causes hypertension? The cause of hypertension is unknown in most of the cases. Sometimes, hypertension occurs secondary to kidney disease or adrenal gland disease. Who are at risk of getting high BP? The risk of developing high blood pressure is more in people above the age of 45, those who have close relatives already suffering from hypertension, and who have history of diabetes, Many people consistently have blood pressure above normal, yet not so high to be called as hypertension (130-140 /80-90). These people are at more risk of developing hypertension. Is salt and blood pressure are related? Sodium content of salt causes water retention thus putting more burden on heart and raising blood pressure. So watch the foods you eat for sodium content and stick to a low-sodium diet. Stress and high blood pressure Stress can increase the blood pressure, but no scientific facts to suggest that it causes hypertension. Stress can lead to addictions, poor diet, lack of sleep which can indirectly contribute to high blood pressure and heart disease. Obesity and hypertension Obesity strains heart and raises the risk. Losing every kilo makes a huge difference. Alcohol  Alcohol can surely raise blood pressure and limiting it mandatory. Pregnancy and hypertension High blood pressure during pregnancy is called as gestational hypertension. It can cause serious complications like preeclampsia. It can harm both the mother and baby. It can compromise oxygen flow to the baby. The blood pressure normalizes after child's birth. Medicines and hypertension Some medicines, like pain killers, birth control pills, steroids, flu medicines etc. can cause the blood pressure to rise. Be careful with the medications. Avoid over-the-counter medications and take doctor's advice before consuming any medicine. "White coat" phenomenon Some people show high blood pressure in doctor's clinic due to nervousness. This is called as white coat phenomenon. These people are at risk of developing high blood pressure. Kids and hypertension Kids who are obese and have a family history are more at risk. How to control high blood pressure? Eat healthy: Eat more fresh fruits, vegetables, whole-grain foods, low-fat dairy products, and nuts. Say no to sweets, saturated fats, and excess salt. Exercise: Regular physical activity lowers blood pressure. Atleast 150 minutes of exercise per week is essential. Activities like brisk walking, swimming, cycling or gardening, all count. Reduce stress: Add yoga, meditation, deep breathing. All have proven to lower the blood pressure and keep it normal. Hypertension is usually a chronic life-long condition. It's very essential to take medications, make lifestyle changes and regularly monitor blood pressure. Keeping it under checkwillreducethe potential riskof heart disease, kidney diseases, and stroke.
Diabetes paves the way to cancer!Diabetes mellitus is common across the world. So common, that people don't take it seriously. It appears relatively benign on a day-to-day basis. It is just a sugar level that you notice on the outward. Controlling diabetes means a change in the lifestyle. It is easy to pop in some pills to battle a disease. The difficulty lies in making long-term changes in our daily routine. We tend to get lazy and make excuses for not being able to follow a discipline in lifestyle. This happens more so with diabetes because we do not see an apparent damage that is being done by the high blood sugar. Unless the levels go really high or drop very low, there are no major symptoms that affect our activities from morning to evening. What we are unaware of is that the disease is making some serious damage insidiously. It affects multiple organs and processes. These effects cannot be directly noticed but are continuously ongoing. By the time we wake up, a lot of injury has already occurred. Here is some more bad news. A large number of scientists in all countries are working day and night to study the course of diabetes and bring new facts to light.  Recent researches have established a new link - cancer. Yes, diabetes increases the risk for breast cancer and colon (intestinal) cancer. A woman who has diabetes, is at 20 times more risk for developing breast cancer. Breast cancer A peculiar association of diabetes and breast cancer has come in the picture in the last few years. Factors contributing to these are many - sedentary lifestyle, overweight, rich food, etc. Another important contributor is hormonal imbalance due to diabetes. As a result of high sugar and high insulin in the body, twofold changes occur in the hormonal cycles which ultimately lead to excess estrogen circulation in blood. This, in turn, may act as a trigger for breast cancer. Breast cancer is relatively easy to diagnose. When detected in early stages, treatment has shown remarkable affects. Colon cancer Cancer of the intestine is one of the most common cancers worldwide. Scientists are still working on finding the exact cause but a clear relationship between diabetes and colon cancer has been proven. Patients suffering from high blood sugar have a higher risk of developing intestinal cancer than those with normal blood sugar. Colon cancer is often seen to be fatal and rate of recurrence is quite high. Worldwide several researches have shown a strong connection between diabetes mellitus and occurrence of breast and colon cancer. Suggestions If you have normal blood sugar levels, please put in your best effort to maintain the same. If you are at risk for diabetes because of significant medical history, take extra care and precaution to prevent or delay the onset of the disease. This can be done by regular and adequate exercise, along with the balanced food options. If you have been diagnosed with diabetes, work on your lifestyle to keep the sugar levels in control. Regular check-ups and frequent monitoring of blood sugar levels are a must. If you are a diabetic, please go for periodical screening of related health conditions. Specific to the topic at hand, please get regular breast examinations. Physician recommended and supervised mammograms and colonoscopies would be extremely helpful. Eyes wide open? Now, will you pay attention to all the restrictions advised by your doctor? Please do. Get that lifestyle which is recommended. Compromise on your work and cravings; focus on exercise and eating healthy. Diabetes is not a killer if managed effectively. Don't let cancer get a hold on you.
Pulling out - Is it an effective option for contraception?What is the 'Pulling out' method? 'Pulling out', 'Withdrawal' and 'Coitus Interruptus' are all the different names for probably one of the safest methods of contraception. It involves the male partner withdrawing or pulling out his penis just before ejaculation. This ensures that no semen has been ejaculated into the vagina or vulva of the female partner. Since there are no sperms travelling inside, the result is - No Pregnancy! Is this method really effective? Like all methods of contraception, the effectiveness of the pulling out method also depends on how correctly it is done. This method requires a lot of mutual understanding between the partners. The male partner must also exercise great self-control and accuracy in knowing when he will reach the highest point of sexual excitement so he can pull out at the right moment. Statistics have the following things to say Of women whose partners use withdrawal, 4% become pregnant each year if they always do it correctly, and 27% become pregnant each year if they don't always do it correctly. Ejaculating close to the vagina or vulva would mean that the sperms still have a way to travel inside the vagina. At times the pre-ejaculate fluid may also contain a few sperms from the previous ejaculation that may end up causing pregnancy. As a precaution against this, experts suggest the male partner pass urine before the sexual act. Withdrawal method of contraception is the best option for members of religious groups in which using contraceptive devices like pills, condoms or IUDs are a form of sin. Withdrawal method does not protect you from HIV/AIDS and other STDs. What are the advantages and disadvantages of this method? Advantages It is simple, safe and convenient. It is the best method when no other contraceptive method is available. It has no side-effects It does not require a medical prescription. It does not alter the menstrual cycle. It does not affect future fertility. Disadvantages Requires great self-control, experience and trust. Not suitable for men who suffer from premature ejaculation Not suitable for teenagers and sexually inexperienced people. Does not ensure protection from sexually transmitted diseases and HIV/AIDS. Less effective than other methods of birth control. May interfere with sexual pleasure due to nervousness and anticipation of pulling out at the right time. The pull out method is thus one of the safest methods of contraception, provided one has a thorough understanding of one's body, trust in the partner and a huge amount of self-control.
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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