DESCRIPTION: Treatment with aromatase inhibitors for postmenopausal women with breast cancer has been shown to reduce or obviate invasive procedures such as hysteroscopy or curettage associated with tamoxifen-induced endometrial abnormalities. The side effect of aromatase inhibitors, diminished estrogen synthesis, is similar to that seen with the natural events of aging. The consequences often include vasomotor symptoms hot flushes and vaginal dryness and atrophy, which in turn may result in cystitis and vaginitis.Chris Juarez: Italians can be the most loving people but if u cross them then u will die just ask my family lmao
Arianna DG: why do you make vids about SEX
Kelo Gii: Very funny and enjoyable
Istayup: Unfortunately there are people with this macho and sexist thinking about women. If you are direct in the relationship, you are a whore. How ignorant, change your concepts about women, especially Brazilian women who are the target of sexist criticism
Grethan Lane: What a racist video
Studio Edin: Where is a Slovak language?
Fatalitydead: She is a great actress.
Aimee Luna: I hate russian women, and im russia. daang
Tutuko Radite: Portugues do Porto (y)
Danny Hughes: Russian ABOUT American: Strange smile face, MacDonalds, How you (life on slang),
Brittany: As an Indian I will say that Indian girls suck
HelinaSings: Canelos twin is hot lol
Napoleon4778: Why no mean comments? I mean like if there were any other country where English is NOT native language, then that'd be made fun of, I guess.
Steven C: Also in my opinion it's possible to love multiple people at the same time. I find it quite sad that many people don't realize that. It makes me uncomfortable if a guy thinks that I only belong to him. I'm nobody's property. You can't own a person. The best idea is to either stay single or find a spouse/spouses that think the same way about relationships, love, sex and all that kind of stuff.
Carlo Nati: Awww, that's a shame that men in Toronto are experiencing this! I've dated a Toronto man for close to years and it a wonderful experience! This is a nice starter video, but i would like to know why women in Toronto are aloof, and off-putting to the men there? I'm considering moving to Canada and that would be valuable info!
Joa Domi: Love you shake
Matthew Winch: Wheres german ?
Sascha D: I honestly could not disagree with this video more . I love lacy but oh my god every point on this video
Jack Krusell: Also, are you going to do Poland?
Emily Mills: My question is, does regular use of vibrators reduse sensitivity during sex without the toys?
Ivan Petrov: Guy in white tshirt looks like messi
Brain Fire: From what you wrote it seems you didn't read their entire comment~
Daria Podenok: Seems like all the men tried to predict a woman's personality based solely on her looks while the women judged them on their actual beauty.very interesting!
CГЎtia Lima: You are stupid
Jacob Pieters: Hi 5 for potatoes from Germany!
Darz Bor: Omg youвЂ™re dumb
Stuart Miller | Litigation | Sexual Harrassment |Star Island
; Roger Scruton's criticism of, ; sexual dysfunction, , ; equality in marriage, ; as liberal feminist, ; married to John Stuart Mill, Miller, Casey: on sexist language, Miller, Geoffrey: sexual selection, . Dec 9, A former housekeeper at the home of Lennar CEO Stuart Miller sued him after she reported sexual harassment by another household. The complexity of female sexual dysfunction necessitates a biopsychosocial .. has sexual concerns that may contribute to the woman's sexual dissatisfaction;.
Treatment with aromatase inhibitors for postmenopausal women with breast cancer has been shown to reduce or obviate invasive procedures such as hysteroscopy or curettage associated with tamoxifen-induced endometrial abnormalities. The side effect of upfront aromatase inhibitors, diminished estrogen synthesis, is similar to that seen with the natural events of aging.
The consequences often include vasomotor symptoms hot flushes and vaginal dryness and atrophy, which in turn may result in cystitis and vaginitis.
Not surprisingly, painful intercourse dyspareunia and loss of sexual interest decreased libido frequently occur as
Stuart miller wife sexual dysfunction. Various interventions, both non-hormonal and hormonal, are currently available to manage these problems.
The purpose of the present review is to provide the practitioner with a wide array management options to assist in treating the sexual consequences of aromatase inhibitors.
The suggestions in this review are based on recent literature and on the recommendations set forth both by the North American Menopause Association and in the clinical practice guidelines of the Society of Gynaecologists and Obstetricians of Canada. The complexity of female sexual dysfunction necessitates a biopsychosocial approach to assessment and management alike, with interventions ranging from education and lifestyle changes to sexual counselling, pelvic floor therapies, sexual aids, medications, and dietary supplements—all of which have been reported to have a variable, but often successful, effect on symptom amelioration.
Although the use of specific hormone replacement—most commonly local estrogen, and less commonly, systemic estrogen with or without an androgen, progesterone, or the additional of an androgen in an estrogenized woman or a combination —may be highly effective, the concern remains that in patients with estrogen-dependent breast cancer, including those receiving anti-estrogenic adjuvant therapies, the use of these hormones may be attended with potential risk. Therefore, non-hormonal alternatives should in all cases be initially tried with the expectation that symptomatic relief can often be achieved.
First-line therapy for urogenital symptoms, notably vaginal dryness and dyspareunia, should be the non-hormonal group of preparations such as moisturizers and precoital vaginal lubricants. In patients with estrogen-dependent breast cancer notably those receiving anti-estrogenic adjuvant therapies and severely symptomatic vaginal atrophy that fails to respond to non-hormonal options, menopausal hormone replacement or prescription vaginal estrogen therapy may considered.
Systemic estrogen may be associated with risk and thus is best avoided. Judicious use of hormones may be appropriate in the well-informed patient who gives informed consent, but given the potential risk, these agents should Stuart miller wife sexual dysfunction prescribed only after mutual agreement of the patient and her oncologist.
With more than a million new cases and more thandeaths worldwide annually, breast cancer is a major cause of morbidity and mortality 1. The clinical efficacy of adjuvant endocrine therapies in hormone-dependent breast cancer is the key to successful intervention. However, therapeutic standards and guidelines also emphasize that effective patient compliance
Stuart miller wife sexual dysfunction that safety and tolerability be addressed. Because of their greater efficacy in reducing recurrences as well as their better tolerability profile, the third-generation aromatase inhibitors ai sincluding anastrozole Arimidex: Pfizer Canada, Kirkland, QCare increasingly being recommended as adjuvant therapy in postmenopausal women with Stuart miller wife sexual dysfunction cancer.
Stuart miller wife sexual dysfunction contrast to a selective estrogen receptor modulator such as tamoxifen, which acts as an estrogen agonist in some tissues for example, bone or endometrium and an antagonist in others for example, breastai s produce profound suppression of estrogen in all tissues by blocking the cytochrome P aromatase complex that converts androgens to estradiol, which underlies the estrogen receptor er —positive mammary carcinogenesis 2 — 4.
The steroidal inhibitor exemestane, at a single oral dose of 25 mg, leads to prolonged reduction in plasma and urinary estrogen levels, with maximal suppression of circulating estrogens occurring 2—3 days after dosing and persisting for 4—5 days 3.
The nonsteroidal ai s—anastrozole, at a dose of 1 mg daily, and letrozole, at a dose of 2. Furthermore, these third-generation ai s do not compromise glucocorticoid or mineralo-corticoid production or thyroid function 89. Tamoxifen exerts its estrogen agonist effect by binding to the er on endometrial epithelial and stromal cells, thereby stimulating abnormal cellular proliferation and increasing the risk of polyps, hyperplasia, and endometrial cancer by a multiple of 2—4 times compared with patients not receiving tamoxifen 10 — Within 3 months of initiation of tamoxifen Stuart miller wife sexual dysfunction, significant increases in endometrial thickness and in uterine volume are reported, including endometrial cysts and polyps and growth of pre-existing fibroids The American Society of Clinical Oncology Technology Assessment Panel supports the use of ai s as appropriate initial treatment for women with contraindications to tamoxifen, or for example, in women who develop invasive breast cancer while taking a selective estrogen receptor modulator for breast cancer reduction or bone loss Clinical studies have clearly demonstrated the safety of steroidal and nonsteroidal ai s from a gynecologic viewpoint.
Data from the
Stuart miller wife sexual dysfunction major phase iii trials of ai s, including the Arimidex, Tamoxifen, Alone or in Combination study atacma. Each of the ai s is associated with its own side effect profile.
For most women, the ai -induced hypoestrogenic side effects are manageable. Nonetheless, to appropriately address side effects, a careful and comprehensive clinical evaluation needs to be undertaken to determine which of the gynecologic symptoms are attributable to menopause and which are attributable Stuart miller wife sexual dysfunction other causes.
Results from the atac trial, investigating upfront treatment with anastrozole as compared with initial tamoxifen therapy in postmenopausal women with early breast
Stuart miller wife sexual dysfunction, showed a significantly lower incidence of hot
Stuart miller wife sexual dysfunction, endometrial cancer, and vaginal bleeding and discharge with anastrozole As well, anastrozole was associated with significantly fewer adverse gynecologic events in four categories Notable also was the fact that, of the patients who experienced gynecologic adverse events, those on anastrozole required fewer diagnostic Furthermore, patients on anastrozole underwent hysterectomy at a quarter of the frequency seen among patients on tamoxifen [1.
Fewer gynaecological adverse events, gynaecological intervention, endometrial changes and abnormalities with anastrozole Stuart miller wife sexual dysfunction with tamoxifen: Poster presented at the 10th International St. Gallen Oncology Conference; St.
Gallen, Switzerland; March 14—17, ]. Most of the gynecologic adverse events and endometrial abnormalities in the atac trial occurred within the first 2.
The subprotocol analyses also revealed both fewer endometrial abnormalities and fewer medical interventions during the first 2 years with anastrozole therapy than with tamoxifen Gallen, Switzerland; March 14—17, These results are consistent with findings from an open-label randomized trial that compared, in postmenopausal breast cancer patients, the effects of switching to anastrozole following adjuvant tamoxifen treatment after more than 12 months, but fewer than 48
Stuart miller wife sexual dysfunction with the effects of continued use of tamoxifen, histologically confirming tamoxifen-induced endometrial pathology polyps, hyperplasia, and glandulocystic atrophy The difference between groups in recurrent vaginal bleeding [anastrozole: Also, significantly fewer patients who switched to anastrozole required repeat hysteroscopy or dilatation and curettage as compared with patients continued on tamoxifen [4 of 83 patients 4.
By inhibiting estrogen synthesis, the third-generation ai s reduce endometrial thickness and uterine volume in patients previously treated with tamoxifen Figure 2 However, patients anastrozole alone reported more vaginal dryness, painful intercourse dyspareuniaand loss of sexual interest, but significantly fewer cold sweats and less vaginal discharge 2829 than did patients on tamoxifen alone.
Changes in double endometrial thickness DET from baseline to 3 months of treatment with tamoxifen and with aromatase inhibitors For patients who are intolerant to tamoxifen, switching to letrozole has been shown to reduce the frequency of hot flashes In the big 1—98 trial, patients on letrozole experienced fewer hot flashes than did those on tamoxifen However, in the ma.
In subset analyses, women receiving letrozole experienced more bodily pain and menopausal symptoms and Stuart miller wife sexual dysfunction greater compromise in sexual function As compared with tamoxifen, the steroidal aromatase inhibitor exemestane has been shown to result in more frequent vaginal dryness, but less vaginal discharge and bleeding 34 The gynecologic signs and symptoms associated with diminished estrogen levels, such as urogenital atrophy, vaginitis, dyspareunia, and loss of sexual interest, may affect quality of life to varying degrees in postmenopausal women receiving adjuvant ai therapy.
Female sexual dysfunction fsd is multifactorial, involving physiologic, psychologic, social, emotional components. Delineation into four diagnostic groups is clinically helpful 36 Many physiologic, psychologic, interpersonal, and sociocultural factors may contribute to fsd Table I These can range from age- or Stuart miller wife sexual dysfunction causes to results of surgical or therapeutic interventions.
In addition, sexual motivation and performance can be affected by psychosexual issues. Having breast cancer is itself an additional factor in fsd. Breast cancer treatment may cause early and more severe menopausal symptoms, as well as fear and anxiety, body-image concerns, and sexual dysfunctions arising from cancer treatment—induced urogenital changes.
Factors underlying female sexual dysfunction A variety of female sex hormones, including estrogens, androgens, progesterone, prolactin, oxytocin, and glucocorticosteroids, have been implicated in normal female sexual function. As they interact with neurotransmitters such as serotonin, catecholamines, and dopamine within the central and peripheral nervous system, each of these hormones and their receptors are regulated Stuart miller wife sexual dysfunction co-activator and co-repressor proteins through both endothelium-dependent and -independent mechanisms Furthermore, steroid hormones can be produced within cells in peripheral target tissues and remain there.
Although these hormones are not found within the systemic circulation, they are believed to exert an important local effect—a process called intracrinology The specific roles
Stuart miller wife sexual dysfunction these individual hormones in sexual responsiveness have been difficult to identify clearly.
Complaints of sexual dissatisfaction or dysfunction in postmenopausal women merit thorough evaluation:. Unquestionably, local vaginal factors should be addressed in ai -treated women, as well as in all women with sexual difficulties.
If local factors are deemed to be an issue, local treatment with vaginal moisturizers and precoital lubricants should be initiated.
Stuart miller wife sexual dysfunction vaginal dryness or lack of elasticity with resulting dyspareunia persist, and if the resulting sexual dysfunction is distressing to the patient, local treatment with vaginal estrogens may be considered. Consideration of systemic estrogen therapies, rarely indicated for vaginal complaints, should be reserved for those women whose severe and distressing systemic symptoms for example, severe vasomotor disturbances fail to respond to non-hormonal therapies for example, clonidine, selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors.
Obtaining a detailed sexual history is not only critical to addressing appropriate sexual concerns, Stuart miller wife sexual dysfunction is also therapeutic in itself. Faced with a life-threatening disease, women with breast cancer may feel that their altered sexuality is not a medically legitimate complaint, or that their health care professionals view sexual changes as irrelevant to other issues or are uncomfortable addressing sexual issues.
However, sexual dysfunction is well known to interfere with both quality of life and the recognized need for intimacy during cancer diagnosis and treatment. It is therefore important to include questions that address the possibility of sexual concerns. Many patients may be reluctant to mention it themselves. Cancer treatments and reduced hormone levels may result in lowered mood, fatigue, and loss of sexual interest not only because of the aforementioned stressors, but also because of a reduction in sexually satisfying experiences as a result of dyspareunia or other gynecologic effects of cancer treatment.
With any sexual dysfunction, assessing the resulting degree of personal distress while evaluating the patient for physical, psychosocial, organic, and biologic aberrations is important Screening for depression, chronic illness, or therapy causing adrenal suppression is essential. In regard to the latter, results from a randomized double-blind multicentre trial indicate that ai s such as oral letrozole at daily doses of 0.
Finally, from a medical viewpoint, sexuality encompasses more than genital functioning. Bladder and bowel issues, altered genital sensation, mobility limitations, pain from concomitant medical conditions, presence of a non-cancer-related chronic illness, fatigue, use of medications other than those for cancer, sexual self-image and self-esteem, partnership, motherhood, and parenting issues all affect the sense of sexual self and sexual functioning It is advisable to ask patients questions about these issues.
The next subsection illustrates an approach that can be used. General assessment should include thyroid status; cardiovascular, musculoskeletal, and neurologic parameters; breast examination for further pathology or hyperprolactinemia nipple discharge ; and signs of anemia.
A complete gynaecologic assessment should encompass these possible sources of sexual difficulties 42 Impaired vaginal and rectal muscle tone, pelvic floor hypertonicity, or poor or absent bulbocavernosal reflex may suggest possible sources of sexual difficulty. Table II lists suggested biochemical investigations Drugs such as ai s that block ovarian function effectively reduce androgen levels.
Finding a low serum testosterone level is neither diagnostic nor predictive of sexual dysfunction. Thus, it is generally agreed that serum testosterone determinations should not be used to make a diagnosis. The major role of testosterone determination is in monitoring testosterone therapy to ensure that testosterone levels remain within the acceptable normal range Although androgens decline with age in all women, no consensus yet exists on normal age-related levels, because large numbers of control and dysfunctional populations alike need to be screened for levels of androgens and their metabolites.
Another challenge is the development of a reliable assay specifically for the lower levels of testosterone found in women The current view is
Stuart miller wife sexual dysfunction the total testosterone assay, which measures both freely circulating testosterone and the portion bound to protein, is inaccurate for women with lower ranges of serum testosterone In the Canadian context, levels of free testosterone not bound to sex-hormone globulin and bioavailable testosterone free testosterone and testosterone loosely bound to albumin are considered more indicative of cellular or bioactive status than is the total Stuart miller wife sexual dysfunction level.
However, the concept of intracrinology mentioned earlier further Stuart miller wife sexual dysfunction the picture. Basic biochemical investigations for women presenting with low libido
That potentially life-saving surgery leads to premature menopause, frequently resulting in distressing and unaddressed sexual dysfunction. Feasibility and primary outcomes including sexual dysfunction and psychological woe were assessed.
This single-arm lawsuit included a one-time, half-day academic session comprised of targeted progenitive health education, body awareness and relaxation training, and mindfulness-based cognitive therapy strategies, followed by two sessions of tailored telephone counseling.
Assessments were completed at baseline and two months post-intervention. Con endpoints include feasibility and effectiveness as reported by the sharer.
Thirty-seven women completed baseline and post-intervention assessments. At baseline, participants had a mean age of Women were highly satisfied with the intervention content and reported utilizing new skills to manage sexual dysfunction.
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Girlfriends friend said she should dump me, how to react?The complexity of female sexual dysfunction necessitates a biopsychosocial .. has sexual concerns that may contribute to the woman's sexual dissatisfaction;. Hormonal aspects of sexual dysfunction: The therapeutic use of exogenous androgens in men and women. Authors; Authors and affiliations. Stuart N. Seidman..