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Contraception, sex and relationship, Sex Health

Menstruation

The endometrium is under the influence of sex steroids that circulate in females of reproductive age. Sequential exposure to oestrogen and progesterone will result in cellular proliferation and differentiation, in preparation for the implantation of an embryo in the event of pregnancy, followed by regular bleeding in response to progesterone withdrawal if the corpus luteum regresses. During the ovarian follicular phase, the endometrium undergoes proliferation (the ‘proliferative phase’); during the ovarian luteal phase, it has its ‘secretory phase’. Decidualization, an irreversible process  that develop a specialized glandular endometrium, and apoptosis arise when there is no embryo implantation. Menstruation (day 1) is the shedding of the ‘dead’ endometrium and ceases as the endometrium regenerates (which normally happens by day 5–6 of the cycle).

The endometrium is composed of two layers, the uppermost of which is shed during menstruation. A fall in current levels of oestrogen and progesterone for about 2 weeks after ovulation leads to reduce of tissue fluid, vasoconstriction of spiral arterioles and distal ischaemia. This results in tissue breakdown, and loss of the upper layer along with bleeding from fragments of the remaining arterioles is seen as menstrual bleeding. Enhanced fibrinolysis reduces clotting.

The effects of oestrogen and progesterone on the endometrium can be reproduced artificially, for example in patients taking the combined oral contraceptive pill or hormone replacement therapy who experience a withdrawal bleed during their pill free week each month.

Vaginal bleeding will cease after 5–10 days as arterioles vasoconstrict and the endometrium begins to regenerate. Haemostasis in the uterine endometrium is different from haemostasis elsewhere in the body as it does not involve the processes of clot formation and fibrosis.

In rare cases, the tissue breakdown and vasoconstriction does not occur correctly and the endometrium may develop scarring which goes on to inhibit its function. This is known as ‘Asherman’s syndrome’. The endocrine influences in menstruation are clear. However, the paracrine mediators less so. Prostaglandin F2a, endothelin-1 and platelet activating factor (PAF) are vasoconstrictors which are produced within the endometrium and are thought likely to be involved in vessel constriction, both initiating and controlling menstruation. They may be balanced by the effect of vasodilator agents, such as prostaglandin E2, prostacyclin (PGI) and nitric oxide (NO), which are also produced by the endometrium. There is a research shows that progesterone withdrawal increases endometrial prostaglandin (PG) synthesis and reduces PG metabolism. The COX-2 enzyme and chemokines are involved in PG synthesis and this is likely to be the target of non-steroidal anti-inflammatory agents used for the treatment of heavy and painful periods.

Endometrial repair involves both glandular and stromal regeneration and angiogenesis to reconstitute the endometrial vasculature. VEGF and fibroblast growth factor (FGF) are found within the endometrium and both are powerful angiogenic agents. Epidermal growth factor (EGF) appears to be responsible for mediation of oestrogen-induced glandular and stromal regeneration. Other growth factors, such as transforming growth factors (TGFs) and IGFs, and the interleukins may also be important.

Greater understanding of mediators of menstruation is important in the search for medications to control heavy and painful periods. Mefenamic acid is a PG synthetase inhibitor which is widely used as a treatment for heavy menstrual bleeding. It is believed to act by increasing the ratio of the vasoconstrictor PGF2a to the vasodilator PGE2. Mefenamic acid reduces menstrual loss by a mean value of 20–25 per cent in women with very heavy bleeding, and further more effective agents are still being sought.

Treatment for soft erection

dating, sex and relationship, Sex Health, Sex Life Story

8 mistakes that women do for men

Even the smartest women are sometimes able to make the most stupid and ridiculous errors.

Trying to solve his problems

If a man constantly complained of unpleasant work, forever screaming kids or poor relations with his mother, who forcibly visited twice a year – this is not a cry for help to you!

The man, is able to independently solve issues that bear his unpleasant feelings: to find a new job, to fix relations with his colleagues to spend more time with the kids and the whole family. If not matured to such steps, better leave it alone.

You think your old relationships are still important to him

If these relations are completed, so this is no reason.

No need to try to dig into his past, you’d better try to create a wonderful present. Eventually, you have to have respect for his privacy, when you have not attended it. You mentally calm, that he was not aware of what he was doing. Well, remember though that we are not out of the monastery directly to a meeting with him.

Conducted as a slave under the dominion of man

Naturally, no one has canceled the historical role of women in marriage, but it is unnecessary extremes to forget about their education, career, hobbies and friends just because you have a spouse, who must cherish.

Find a happy medium to be happy and you yourself.

Nothing changes in your life, when the man appeared

Yes, it is necessary to disappear from the sight of his friends, but not to stop with night parties or permanent missions is not correct.

You already have two, you have to think how you can spend more time together and to seek compromise.

Do not pay attention to how and what he talks about other women

We are all mature girls and not allow unreasonable fits of jealousy.

But everything has its limits: his stories for appetizing accountant or former reminder – this is pure outrage! If tact is not the strong side of your husband, then a direct request not to talk too much about the other women would be completely normal.

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Returning to the former again and again

Again reminded that when a relationship is over, they are over. And point.

This is not a game where there is time out for rest and after her turbulent romance continues. Mostly refers to those men who made us suffer. He will not change, will not start to behave otherwise, everything will gradually reach that point where relations have been suspended yet again.

Trying to find the perfect man

As perfect as you perceive him.

It is time to accept the fact that men are completely different types of people that radically differ from us women. Beautiful, two senior, three languages, beautiful mother in law and the absence of harmful habits – or description of a person with manic tendencies, or a man who is looking for the same such a perfect wife (which does not exist).

Pains to be better than his mother

For each man the mother as a separate island where can always go and cry unfulfilled dreams.

Mom is the one who will suffer with it even when her son was a complete failure. It is therefore entirely logical her eager attitude of the children to the mother. And it is not worth trying to borrow its place will one day have his own children.

Treatment for Soft Erection

sex and relationship, Sex Health

Adenomyosis

Adenomyosis is the condition of an ingrowth in the endometrium, both glandular & stromal components, directly into the myometrium.

Causes: The cause of such ingrowth is not known. It may be related to repeated childbirths, vigorous curettage or excess of estrogen effect. Pelvic endometriosis co-exists in about 40 percent.

Pathogenesis: Histologically, it is characterized by the extension of endometrial glands and stroma beneath the endometrial—myometrial interface (EMI). As the submucosa is absent, endometrial glands lie in direct contact with the underlying myometrium. It forms nests, deep within myometrium. Subsequently, threre is myometrial hyperplasia around the endometriotic foci. Myometrial zone anatomy was observed by MRI. A junctional zone (with low signal intensity on T2 weighted images) is defined at the innermost layer of myometrium. It is thought that the disturbance of normal junctional zone (JZ) predisposes to secondary infiltration of endometrial glands and stroma to inner myometrial zone. The disturbance of junctional zone (JZ) may be due to the endometrial factors, genetic predisposition or altered immune response. Trauma to the deeper endometrium (repeated curettage), causing breakdown of EMI is also taken as an important etiologic factor.

Pathology: The growth and tissue reaction in the endometrium depend on the response of the ectopic endometrial tissues to the ovarian steroids. If the basal layer is only present, the tissue reaction is much less, as it is unresponsive to hormones. But, if the functional zone is present which is responsive to hormones, the tissue reaction surrounding the endometrium is marked. There is hyperplasia of the myometrium producing diffuse enlargement of the uterus, sometimes symmetrically but at times, more on the posterior wall. The growth may be localized or may invade a polyp (adenomyomatous).

Naked eye appearance: There is diffuse symmetrical enlargement of the uterus; the posterior wall is often more thickened than the anterior one. The size usually does not increase more than a large orange (12–14 weeks pregnant uterus). On cut section, there is thickening of the uterine wall. The cut surface presents characteristic trabeculated appearances.

Unlike fibroid, there is no capsule surrounding the growth. There may be visible blood spots at places

 In about one-third, it remains asymptomatic being discovered on histological examination. The patients are usually parous with age usually above 40.

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Symptoms:

Menorrhagia (70%)—The excessive bleeding is due to increased uterine cavity, associated endometrial hyperplasia and inadequate uterine contraction. During normal menstruation, there are antegrade propagation of subendometrial contractions from the fundus to the cervix. In adenomyosis with distorsion of junctional zone myometrial contractions are abnormal and inadequate (see below).

Dysmenorrhea (30%)—Progressively increased colicky pain during period is due to retrograde pattern of uterine contractions. It also depends on the number and depth of adenomyotic foci in the myometrium. When the depth of penetration is > 80% of the myometrium, the pain is severe. Other causes of pain are—local tissue edema and prostaglandins.

Dyspareunia or frequency of urination—are due to enlarged and tender uterus.

Infertility: Women with adenomyosis have a higher incidence of infertility and miscarriage.