How to Cure Female Impotence
Female Impotence and How to Cure It
Female Impotence and How to Cure It
Martha Jacobs is a specialist in women's health and has helped many a women improve their sex lives through natural products and cures. |
Female Impotence
Female Impotence
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T H E N U T S A N D B O L T S O F T H E F E M A L E P E L V I S ||
(voluntary urination) or escape the normal suppressive channels (resulting
in leakage). It can thicken due to pushing against a resistance (like the biceps
muscle) or it can be thin and paper-like, with no change in symptoms. It
can be overdistended and lose its ability to function for weeks or months
on end, only to become decompressed and return to normal activity within
days. In short, it is quite a resilient muscle that is at the root of many urination
problems among men and women.
In women, the detrusor muscle tends to be thin and floppy. Because
women don’t have prostates to block the flow of urine, they never develop
the thick-walled muscle from which men with enlarged prostates suffer.
Women suffer from the opposite problem; as a woman ages, her urinary
sphincter becomes less efficient, creating less resistance to outflow, often
resulting in incontinence. In older women, nothing exists between the
bladder and the outside except a very inefficient valve. This is one reason
why women suffer from incontinence more than men.
The second reason that men don’t develop incontinence is also related
to differences in their anatomy. Men have a prostate that supports the
bladder (the prostate provides the juice in which the sperm swim around
in the ejaculate). Because of that support, and the fact that no empty cavity
sits under the bladder (in women, that would be the vagina), a man cannot
suffer from a “fallen bladder” (more about that later). So, anatomically,men
and women are very different in this area, resulting in different problems
requiring different treatments.
The final path of the urine as it leaves the urinary bladder is through
the urethra. In women, the urethra is only 3 cm long (about 11/2 inches);
whereas in men, it is about 15 cm long (about 8 inches). This tiny tube sits
above the vagina inside the labia.Many women do not realize that the urine
comes out of a separate opening.Women have three openings: the urethra,
through which urine passes; the vagina, through which a baby passes; and
the anus, through which stool passes. Men only have two openings: one at
the tip of the penis, the urethra, for both urine and semen; and one behind,
the anus, for stool.
The urinary sphincter comprises about one-half the length of the
urethra in women. As a muscle, the function of the urinary sphincter is to
hold urine in the bladder while the bladder is filling without letting a drop
come out. During voluntary urination, the urinary sphincter opens and lets
the urine pass out into the toilet. It clamps shut when the bladder is empty
in order to allow for bladder filling to resume. It is always contracted and
closed, except for the few seconds each day that it relaxes in order for the
bladder to empty.
T H E N U T S A N D B O L T S O F T H E F E M A L E P E L V I S
T H E N U T S A N D B O L T S O F T H E F E M A L E P E L V I S
bladder or a mass growing into the ureters, you will not feel pain despite
the obstruction. Without special testing, the blockage could go unrecognized.
If it is a long-standing obstruction, even with elimination of the
causative factor, the ureter will remain dilated.As long as the urine is passing
from the kidneys into the bladder, the way the ureter looks is not
important.
Finally, the urine enters the bladder, where it sits until it is eliminated.
Urologists used to think that the bladder was an inactive organ that served
only as a holding vessel. However, with more attention being paid to conditions
that cause bladder pain, researchers are finding that the bladder is a
vital, active organ, with a complex neurological and vascular system.
The urinary bladder (we are not talking about the gall bladder, which
is a small sac that sits under the liver and can fill with stones and cause pain)
is composed of four distinct layers. The lining is called the mucosa.A watertight
system, it protects the inner layers from the toxins that enter the organ.
This active layer of cells gets replaced by new cells on a regular basis. Defects
in the lining that allow urine to penetrate into the deep recesses of the
bladder can cause pain, irritability of the bladder, and frequent urination.
Recurrent infections and chronic pain syndromes may possibly be caused
by these defects.
The next layer is called the submucosa (“under the mucosa”). It is a
thin, indistinct layer through which the blood vessels and nerve endings
enter and supply the other layers. One can see that if the mucosal layer is
imperfect, the urine can easily affect the nerve and blood supply to the
bladder since that is the next layer of exposure.
The third layer of the bladder is the real business end of the organ. It
is the muscle layer, and is formally called the detrusor. The exact character
of the muscle is not known, but it does get thick and muscular when it works
hard to empty against a resistance, just like the biceps muscle gets larger
from weight lifting. However, voluntary control of the detrusor does not
seem possible in the same way that we can control our biceps muscle. There
is a direct, although subconscious, effect that our brains have on the bladder.
In women with certain types of bladder control problems, the detrusor will
contract and cause uncontrollable loss of urine if the brain senses cold,
anxiety, or proximity to a bathroom. As many of you know, suppression of
these impulses is very difficult, making the reaction involuntary but certainly
under some sort of conscious control.
The complex detrusor muscle is different from any other muscle in the
body in that it can expand to huge proportions (like the uterus) and deflate
within seconds (unlike the uterus). It can be controlled by the brain
T
The Nuts and Bolts of the Female Pelvis Normal Anatomy and Physiology
The Nuts and Bolts of the
Female Pelvis
Normal Anatomy and Physiology
In women, the urinary tract is composed of four organs. From top to bottom,
these include the kidneys, the ureters, the bladder, and the urethra. The kidneys
sit under the ribs in the back. Isolated from the organs of the abdomen, the
kidneys are covered in fat and muscle. They filter the blood, reabsorbing the
red blood cells and eliminating toxins into the urine. Also producing agents
that help with the metabolism of calcium and the production of red blood
cells, the kidneys are vital structures. Fortunately, most of us have two of them
but we can live normally with only one. If one kidney becomes diseased, it can
be removed without any negative impact, as long as the other one is normal.
When kidneys become inflamed, they cause severe back pain and fever.
Infections of the kidneys start either in the bladder and ascend into the
kidneys, or they begin in the blood and seed the kidneys. Kidney infections
are serious. They cause high fevers and require long-term antibiotics for
eradication. Fortunately, only 1 percent of bladder infections in women
ascend the urinary tract and affect the kidneys. The kidneys are very resilient
organs. In an anatomically normal woman, even a severe kidney infection
will not cause permanent damage.
After filtering the blood, the kidneys eliminate toxins from the body
through tiny tubes called ureters. The ureters are conduits through which
the urine passes on its way into the bladder. If there is a blockage below the
kidneys, the ureters will become dilated and will fill with water. As anyone
who has had a kidney stone can attest to when the ureters become dilated,
it is excruciatingly painful. A blocked ureter will cause severe, colicky back
pain. The most common cause of urethral obstruction is a stone that forms
in the kidney, gets washed into the ureter, and becomes stuck in the smallcaliber
tube.
If the process causing the blockage is slow-growing, the dilation of
the ureter may not be painful. If the ureters are blocked by a prolapsed
Introduction to Urinary Tract Problems in Women part2
strong bonds that tended to exclude the few women on the service. Urology,
a surgical subspecialty, was a male bastion.
During my fourth year of medical school, I spent a month on the
urology service at the Mayo Clinic, in Rochester, Minnesota.While there, I
learned about the urological problems suffered by women. I also became
aware that there were very few women urologists. No specialty within the
medical profession has fewer women practitioners than does urology. Less
than 1 percent of urologists in the United States are women.
I realized that it is a field in strong need of well-informed female physicians.
I had found my field: I would go into urology, and focus on women’s
urological problems. Ironically, the next time I dealt with urological issues
specific to women was during my fellowship at UCLA Medical Center seven
years later. During my six years of residency, I rarely treated a woman who
suffered with one of the problems discussed in this book, but not because
female patients did not have these conditions. They did, and still do. Rather,
the majority of male urologists in practice did not focus on women’s urological
conditions.
I was the second woman accepted into the urological training program
at Mount Sinai Medical Center in New York City in the history of the
department. The first woman completed her residency about eight years
before I began. She has never practiced urology. Upon completion of her
training, she did a second residency in pathology and became a city Medical
Examiner. I had no women role models from whom to learn. No women
attending physicians trained me, either during my clinical work or my laboratory
experience. I was the only woman in every conference and presentation,
unless one of the radiologists attended.
Because of this isolation, I became acutely aware of the difficulties that
women face when they are seen by male urologists, who traditionally treat
male problems. Of course, most physicians, urologists included, are compassionate
and interested in giving their patients excellent care. After all,
their wives and daughters are women. But most male urologists do not make
an effort to learn and understand female urological disorders.Unless special
interest is taken to think about them, little progress will be made on either
an individual or a scientific level. That is why specialty training is so important.
It is not just the experience that one gets from it, but the focus of one’s
thoughts and ideas in one specific area.
Upon completion of my chief residency year in urology, I pursued a
fellowship in pelvic surgery at UCLA, where I learned about female pelvicfloor
problems and was exposed to the creative and complicated reconstructive
surgery that can be done to correct these problems. I also realized
Introduction to Urinary Tract Problems in Women part3
how desperate our patients are; desperate for information, for answers, and
for education. They flew to Los Angeles from around the world because
access to physicians experienced in this speciality was not available near
their homes.My choice of medical specialty was validated by the fellowship.
During that year, I decided that a book on this subject, written by a committed
medical professional, would be helpful to many women.
Over the past 20 years, tremendous social and financial resources have
been put into research on cancer and heart disease. As a result of the scientific
advances in these areas, people are living longer.
Older Americans
expect to lead active lives playing golf, traveling, and continuing to engage
in sexual relations later in life. Quality of life has taken on new meaning in
the recent decade. Male impotence, once rarely discussed or acknowledged
as a medical issue, is now taken seriously and treated effectively.With more
women physicians treating women patients, we, too, are acknowledging the
importance of lifestyle problems in our patients.
This book serves as a guide for women who are seeking treatment for
the debilitating problems of the urinary tract for their family members. It
touches on disorders that affect millions of women, most of whom have no
idea where to turn for help. In many cases, physicians themselves are not
familiar with the problems from which many of you suffer.
As a clinician
and a surgeon, I am committed to understanding my patients’ problems and
applying the optimal treatment available in order to ease and cure their
urinary tract problems. No book addresses urinary tract problems in
women exclusively. It is my great hope that this book will enlighten women
to better understand their problems and help to ease their embarrassment,
anxiety, and suffering. As more women become assertive in discussing their
concerns in this medical field, more physicians will respond effectively and,
one hopes, empathetically.
I have divided the book into five sections, each of which focuses on
one aspect of the urinary tract. The first section reviews terminology and
anatomy, as well as which medical specialty to turn to for help for your
problems. The second section addresses urinary leakage, of which two main
types occur in women: stress incontinence and urge incontinence. Stress
incontinence occurs when mechanical stress, or pressure, such as laughing,
coughing, or sneezing, causes urine to squirt out of the urethra. The second
type of incontinence, and the cause of much embarrassment, anxiety, and
discomfort for women who are so afflicted, occurs when the urge to urinate
results in leakage before you can get to the bathroom.
The third section deals with pelvic organ prolapse, a condition in
which the bladder, rectum, small intestine, or uterus falls into the vaginal
canal. The fourth section reviews the causes and treatments of the painful
bladder, including urinary tract infections and interstitial cystitis. The fifth
section looks at the effects menopause can have on urological symptoms.
Anesthesia and pain control for urological surgery are also reviewed. Finally,
a glossary provides easy-to-understand explanations for the technical and
medical terms discussed throughout the text.
Introduction to Urinary Tract Problems in Women part1
Introduction
Hardly a glamorous subject, urinary tract problems in women have become
my life’s work. But how did I arrive at this decision? Unlike Aphrodite, I did
not emerge from the medical school clamshell as a urological surgeon and
author. Some autobiographical background is called for.
I grew up in one of the few major cities in America that still has a
single-sex public high school for girls. Before attending the Philadelphia
High School for Girls, I attended a private all-girls grade school in the
suburbs. I transferred to public school in the ninth grade, where I was one
of 550 girls in my year. Everyone was female, including the president of the
student body, the varsity athletes, the entire marching band, the first chair
of the orchestra, the valedictorian, and the editor of the school newspaper.
After graduation, I attended Barnard College, the women’s college of
Columbia University. Although men attend classes in Barnard and the athletic
programs are integrated, Barnard has a distinct place within the University.
I had many female professors and advisors. My female classmates
majored in physics as readily as they did in economics or English. We had
a large number of premedical students with a well-structured mentoring
program of women doctors who had all graduated from Barnard.My desire
to become a doctor did not surprise my friends or family.
The first coeducational institution that I attended was the medical
school of the State University of New York in Brooklyn. Nearly 40 percent
of my class was female, and for the first two years, no perceptible differences
between the education of the male and female students existed. During the
third year, like all American medical students, we spent time in the hospital
learning to evaluate and treat patients. The year is divided into specialties,
such as internal medicine, surgery, and obstetrics and gynecology. At
that time, general surgery tended to be a boys’ club. Long, grueling hours
spent with the same group of eight or ten students, mostly men, created