Selasa, 09 Mei 2017

women hormones

pregnancy brain is otherwise known as momnesia.i think it's real. i've had it. science shows, and there is data on this, that the braincapacity doesn't appear to change. it's very hard to account for function, and there aresome smaller studies showing some memory deficit during pregnancy. it seems to be seems to be related to hormonal changes or neurotransmitter changes. it could alsobe related to lack of sleep, stress, to the

women hormones

women hormones, idea that your brain is put in all differentdirections. your priorities need to change. i think momnesia is real. i think it's fantasticbecause it's telling you to slow down and pull back. it's an opportunity to re-prioritize.if you are overwhelmed and you are doing too many things, you can't remember everythingthat you are supposed to do. maybe that's

your body and your brain to take it down acouple of notches and remember to take care of yourself during the pregnancy.

Senin, 08 Mei 2017


now we're going to talk specifically aboutthe medication that is going to be used with this machine. in my case i have got a prescriptionfor xepenex which is actually for my daughter that was prescribed. you want to make surethat the expiration date, you know that it hasn't expired is very important. obviouslyyou want to make sure that you're using it as prescribed, as directed. most of thesecome in packets and i'll show you a packet


ventolin, that's not open. a foil package just likethis and it has the expiration date right there, so that makes it easy. when you openup each foil packet, you're going to actually see, there will be a couple different you can see right there. so each vial here is actually one use. you want to make surethat the liquid is clear and color free. if

it changes color, in particular with thismedication, then that's an indication that it's gone bad, you don't want to use it. alsothis medication is light sensitive. that's why they have it in the foil. once you openthe foil package and you've been using it, even if you're only needing to use it maybea couple times once a week, once two weeks has past since you've opened it, you needto discard the whole thing. because it's not good anymore once its been opened after 2weeks.

pussy discharge

[ music ] >> good afternoon. thank you all for coming. my name is jo buczkoand i'm the coordinator for student health services.

pussy discharge

pussy discharge, can you hear me? yes. ok. all right, thank you. how many of you know that youhave a student health services here on campus?

ok. all right. so, some of you are going togo home better informed today. student health services'mission statement is to provide quality health andeducation services for you, to empower yourselves soyou can be well-informed and self-directed inyour own health care. and we find when young peoplelike yourselves come in, a lot of times you're comingin from your pediatrician and your parents accompanyyou on your clinic visit.

and now you're here inthe big time and you get to accompany yourselfinto the health center. and so, it's a great opportunityfor you to get access to health care that'sconfidential that is available to you, that doesn't goback to your parents. a lot of times, studentsare worried about something that'svery personal to them. they have questionsabout their health and not comfortable talkingto their parents about it,

and i would encourage you notnecessarily rely on your friends about the information but to come see usat the health center. so, we do have a health centerhere on campus, it's in d105, which is the buildingover there. we have very qualified staff. they're licensed physicians andnurses and nurse practitioners and we have a registereddietitian. and so, we're allthere to help you.

there isn't one personwho works there who doesn't love working there. so we love working withthe college age population. we feel that we havelots of information and services to offer you. and if any of you arejust out of high school, i want you to know that we'rewell beyond the high school nurse model, ok? so, i know sometimes the nursemay give you very limited

information, and pretty muchsometimes they're calling home to ask your parentsto pick you up. you won't see that here, ok? just one of the ways imarket the health center is to talk about the three c's. again, i'm just going to talkabout the confidentiality, what goes on there stays there. none of your teachers,administrators or your parents willknow about it.

there are people--there is a problem-- not a problem but sometimes when you're enteringpcc you're not 18. so if you're not 18, your parents would have signeda consent form that said that you can get services there. we put that in yourregistration form. so, you couldn't register without that formbeing on file with us.

so i just want you to know yourparents have signed off on it. if for some reason there isa loose connection on that and you need help, and there arecertain things we can't help you with but i'm going to tellyou what we can help you with. if you are under 18 and thatconsent form is not signed, we can help you with pregnancy, sexually transmittedinfections and birth control. at the age of 12, you can getaccess to that kind of care in the community withoutyour parent consent.

so i want you to beinformed about that. we also have counselingservices in the respect that we have physicians andnurses there and a dietitian. if you need morepersonal counseling, then i would encourage you to goto psychology services which is in the l building, l108. and that's also free andit comes under your-- the 13-dollar healthfee that you paid at the beginningof the semester.

and then there are clinicalservices, just to let you know, we do a lot of thingsat the health center, and you'll learn a littlebit more about that. but basically allyour visits are free. the health care is free withthe exception of some things that we have to chargeyou for like a lab test, but that's very low cost and themedications are very low cost. and birth control isavailable there too as well, so just for you to be aware of.

so we have two nursepractitioners who are specialistsin women's health, and so they would be a greatresource for the women here, but certainly guyscan see them as well if they have other issues of personal sexualreproductive system concerns. ok. so 411 is just theinformation that we're going to talk about theinformation on stis. now, there are some people herein the front who have clickers.

how many of you are familiarwith clickers already? just a couple of you? ok. these are automateddevices and it's an opportunity for student health services tocollect data on the students, and it kind of gives us asnapshot of who's in the room. so i'm asking thesestudents to wait beyond 1:30. i mean, it might just goright at 1:30 that we'll end. but i need the data, so pleasestay seated till we get all the questions asked at the beginning

and at the end ofthe presentation. ok, so the first question is-- and i'm sorry i forgotto change this over. but what is your age today? are you less than 17, youpress number 1; 17, number 2. if you are 18 tomorrow,you are still 17 today, ok, unfortunately. but we want to get the data soit's accurate of this group. so if you're 20 or more,you're going to press number 5.

we have 30 clickers out, so iknow that what number i'm going for is 30 up here and ihave 23 at the moment. so if you could point uphere to where my receiver is, that would be helpful. if you change yourmind during the-- if you've had answer like"oh, no that's not right" and you want to change it,you certainly can change it. the last one you press is theone that-- thank you very much. the last one you press is theone that's going to register.

so, 70 percent of theclass is 18 right now. ok. so we have noone who is under 17. and 20 percent are 17, and justa couple of there that are 19. what gender do youidentify with, male, female, or gender non-conforming? [ inaudible discussions ] ok, we have one moreperson to press in here. gender non-conforming mightbe someone who is born into a female body but feelsmore male is the kind of a sense

of where they are or amale who feels more female. so we do-- i want you to knowthat we do have a safe campus for students who are questioningwhat their sexuality is. and pasadena city college isworking towards a safe zone area of the whole campus. but in student health services,we do have a safe zone area. ok, so we have 50 percent ofthe group is going to be male and 47 percent female, and 3percent gender non-conforming. ok, 80 percent ofwomen and 50 percent

of men do not have symptoms whenthey're infected with chlamydia. is that true or false? eighty percent of the womenand 50 percent of the men who are infected withchlamydia do not have symptoms. ok, i'm going to ask you guysto click just one more time. ok. so, 43 percent of youfeel that that's true, 57 percent feel it's false. somebody's going tochange their mind today. human papillomaviruses 16 and 18cause cervical cancer in women

and in men cause what? so in women, it causescervical cancer. in men, does it causeoral and throat cancer, penile anal cancers, both oneand two, or neither one or two? ok, if you could justpress one more time because you're not clickingwhen somebody just point up here to the podium area. and we'll see if we cancapture that last person. ok. so 57 percentfeel it's one and two,

and 30 percent justpenile anal cancers and just oral and throat. what is the backup method if the current birthcontrol method may fail? what is the backup method if thecurrent birth control may fail? so is it number onecondoms, plan b-next choice, withdrawal or praying hard? ok. so let's talkabout 50 percent. every person in this room, if wewere to go down the aisle here,

down the rows, every otherperson has not thought about pregnancy and how itmight impact them or someone in their family, orsomeone around them. now, this is male and female. now, certainly, it's goingto affect the female more because her body isgoing to be changing. but just think aboutthis among teenagers. and this is-- your groupis still teenagers-- are still teenagers.

you have to think about this. a lot of times, you're kind oflike in the present and a lot of things are goingon, but you really need to think about pregnancy. and i'm talking aboutmen and women. so on the back table,some of you may have seen that we do have some pamphletson birth control methods, we're going to betalking about that. there's one pamphletthere for the guys,

it said men-- what is it? it's men, babies and the law. so, you might be thinkthis is fun times. but if your partner getspregnant and she has the baby, then you are legally responsiblefor supporting that child until the child is 18. so it's something youneed to be aware of. it's a financialresponsibility legally. ok, 90 percent sexually activeteens not using any birth

control are likely todeal with a pregnancy within the first yearof sexual activity. those are pretty high odds ifyou're not paying attention and getting something to helpyourself to not get pregnant. now i'm going to tellyou the first option that i would strongly support isabstinence because there's a lot of things coming up in theslides in the next part of the presentation that youcan avoid beyond pregnancy. a lot of times, we think aboutpregnancy about birth control.

but the other thingis we want to think about the stis that you can get. so if you're abstinent, you'renot only going to take care of the stis and the-- you'regoing to care of the sti's and the pregnancy together. so we're going to talkabout birth control. this is not meant to be anall inclusive presentation. i can't go over everythingin detail. i just want to give you abrief overview so that you know

that there are optionsbeyond birth control pills. oftentimes, girls will comein, young women will come in and they'll say, "gosh, i reallywant to get birth control." and the question weask, "what is it?" "the pill." they don't have any knowledgeof what's beyond that. so i'm going to show youtoday what is beyond that. but let's go with basicanatomy first because it is-- hopefully, you'll recognizethis as female anatomy.

this is the vagina right here,this is where the penis goes in and this is where thebaby comes out, ok? so this is the uterusright here. it's a muscular body that accommodates anine-month old fetus. there's an opening here, thisis the sperm goes in and this is where the baby's head comes out. so this is all musculature. and then there's two fallopiantubes on either side here

and this is the ovary. the ovary actuallyisn't connected. this picture may looklike it is, but it's not. so in a normal month of atextbook case of a woman, the first day of her periodis the first day of her cycle. and she has a periodmaybe three, four, five days up to seven days. and then she, atmidpoint, ovulates the egg, right-- the ovary, rather.

this is the ovary. it releases the egg. the egg goes up into the tubeand it travels down the tube and it goes and it landsin here in the tissue area. if she's not pregnant,if she doesn't-- if that egg doesn't getfertilize with the sperm, then that just washes outwith the period at day 28, 29. ok, that's textbook,28-day cycle. so first day of the period,

first through sevendays, it may be a period. around day 11 to 15,you're going to ovulate, the eggs have been released. and then around day 28, ifthat egg is not fertilized, it washes out with the period. ok. so, what happens here isthat the-- right in this area, this is normally what happens,if the sperm comes up here, it travels up the tubeand it goes here and meets up with the egg andfertilizes it.

the egg begins todouble in size. from the cellulardivision in biology class, you know that everythingdoubles in size. as it passes through here, it goes down here,it lands in here. so you have a little conceptus or fertilize egg really growingquite nicely when i get here. the plan i want tomake about this, if this is musculaturearea that will expand

with a fetus, thisdoes not expand. this is not made to expand. so it's going to be a criticalpoint for the later part of the presentationto know about that. and just another pointand it was a new fact that i didn't know about till iwas reviewing for some of this that the part of thistube is the diameter of a hair shaft, ahuman hair shaft. so if you think about thediameter or the thickness

of your hair, that's a verysmall diameter on the inside of this tube and that'scritical information to know about for later. so this is what thewoman looks like here. this is the male. he's on the outsidehere with his scrotum. he has two testicles. and this is wherethe sperm begin to develop their production.

and then as they mature and moveon towards their production, they sit up herein the epididymis. and when they're thengetting ready to go through the ejaculation orthe guy cums, then it goes up to the vas deferens, itgoes out behind the bladder, more fluid is addedto the semen. and then it goes out tothe shaft of the penis and through the urethra whichis the opening to the penis, ok? so that's what the guy lookslike and that's the woman.

i did forget to mention atthe beginning of my present-- my opening that i am a nurse,by training, nurse practitioner. and so, i'm bringingclinical photos to you today. they're not all goingto look like this. you're going to seesome real life photos. and so, i'm going to tellyou that can be uncomfortable for you but i'm going toask you to bear with me, ok? ok. so again, thisis just a top view and then this is the cervix.

this is the opening. so if i were to put someoneat the table and look up into the vagina, then i'mgoing to see this opening here. and this is, again,where the sperm goes in and where the periodand the baby comes out. so it looks like a donut. yeah? so when i wasinstructed about this, i was told if you want toknow what it feels like, put your finger on your nose andyou'll know what it feels like.

but i'm going totell you, as a nurse, if you want to knowwhat it feels like, put your finger upthere and feel it. ok. the other nursingpiece of it is that i went to school here, igot my basic nursing. i started out with thelvn program here and one of my nursing instructors wheni was exactly your age, 19, said if you don't know whatyou look like down there, then get a mirror and find out.

now that sounds kindof like graphic but it was really importantfor me to hear and you need to know what you look like. and the reason is becauseif something goes different, if you know somethingisn't quite right, at least you know what you arewhen you're feeling normal. so i encourage men and womento get a mirror and look like-- look what's down there, ok? find out what's normal for you.

you may have some skin lesionsthat are normal for you. you need to know that. ok, so this is areal life picture of what a cervix looks like. and i want to say to the womenthat if you come in to see us at the health center, you canask to see your own cervix. if you go through a pelvic examwith us, we have mirrors there and you can look and see whatyour own cervix looks like. just ask the practitioner,

"can i see what mycervix looks like?" and we'll show it to you, because every cervix it'sa little bit different. ok, so let's talk aboutbirth control methods. there is the sterilizationwhich is what? what's sterilization? where you can't have children. what do they do with guys? they cut the tubes and, withwomen, they cut the tubes.

that's so the egg can'tpass through the tube and the sperm can't come upthrough the tubes for the guy. the guy can still ejaculate. he's still going to have fluid. it's just not going tohave any sperm in it, ok? so that's sterilization. you're likely not going to beinterested in that in this part of your-- in thistime in your life, ok? but we do have implants,

and these are littlelike matchstick-- -- products, and theyhave hormones in them. and they actually fitunderneath your skin. they slide in underneath yourskin and they produce hormones and they stop ovulation. the idea behind hormoneis to stop ovulation so you don't produce an egg. so that slips inunderneath your skin and it stays thereabout five years, ok?

i'm going to pass thesearound so you can feel them. i just hope to seethem at the end. and there's also-- thereyou go, take a look at it. so that you know what it feelslike underneath the skin, you just rub yourfinger across it this way and you'll know what it feelslike underneath the skin. we also have intrauterinedevices. and they look likewhat's up on the screen. it's a t-shaped device.

it's plastic. this particular one hasa copper wire around it. the wire acts as ahostile environment and it's this metal of copper. and it's not a-- it'sa hostile environment in which an egg wouldnot want to be there. so that's the ideaof the way it works. also, the copper islethal to the sperm. it knocks off thehead on the sperm.

there are two different-- actually there are threedifferent types of iuds. this one has metal, itdoesn't have a hormone. the mirena does have a hormoneand it lasts for five years. there's also the skyla oneand i think that's seven years but i'm not exactly sure. so, this one is goodfor 10 years. so i tell the women thatif you're interested in getting a phd or notgetting pregnant for 10 years,

this could be a great option. it's called the long-actingreversible contraception, that's what the implanondoes, the nexplanon. this is an older model butthen we have nexplanon now, and this is good for 10 years. so, you might consider that. they're very popular--beginning to grow in popularity because they don't have hormonesand they're long-lasting. the other thing you need tothink about that you need

to have-- you might wantto have is the shot. the shot, you take onceevery three months. the timing is critical. you have to come inbetween 11 and 13 weeks. but that also is good forwomen who don't want to think about taking a pill everyday or having a deviceinside their uterus. so that's somethingto think about. there are reasons that we haveso many birth control methods

and that is because womenhave medical conditions that they may not beable to take the pill or they may not be able touse this type of device. a shot might be better for them. so, many reasons for differentbirth control methods, ok? we also have the pills,the patch and the ring. and they are-- all theseare hormonal-based. so the pills, you're going to--the whole idea of the pill, the patch and the ringis that you're going

to have an activebirth control method for three weeks outof the month. and then you're going to nothave that method for one week when the woman has a period. so three weeks on thehormone, one week off, you have the period, andthen you restart the cycle. so the pills, you have totake them for three weeks. you have to remember to takethem everyday at the same time. you can't be off-kilterwith that.

it's got to be like 8o'clock every morning or 10 o'clock every night. it doesn't reallymatter the time. what matters is the timing thatyou're taking it every 24 hours. so many of you studentsare taking lots of classes and you're working and you'vegot your other activities that you're involved in and it'shard to keep the hour straight, that may not be agood method for you. the other thing is the patch

which is a hormonethat's on a patch. it goes on your skin andit stays there for a week. so it's on one week,you change the patch, and you change it three times. on the last week, youremove the patch and then that week you have your period. and then there's the ring. the ring, and you're goingto see a system or a pattern with women that youhave a round--

it's a round circlefor women, ok? this is also impregnatedwith hormones and this goes in the vagina and it staysthere for three weeks, and then you take it outand you have a period. so, what's nice about this,and we've heard this a lot, that women come in and they'reconcern their parents are going to find their pillsor their condoms or whatever it's going to be. so if you're putting this inyour vagina for three weeks,

your parents aren'tlikely to find it, right? [ laughter & inaudible remarks ] so, the thing about the-- justabout this to be aware of it, it can come out duringintercourse, so you want to make surethat it doesn't come out. it may come out when you'regoing to the bathroom, so you want to make sure itdoesn't come out in the toilet. so the main thing that youwant to-- if it does come out, you rinse it off andyou put it back, ok?

but the main thing to be awareof is that it is something that is very easy to use. so, it's just one option andyou have to figure it out. now, one thing about this, ifwe're talking about this kind of device, you have tobe comfortable talking-- touching yourself,some women aren't, so that's not goingto be a good option. she doesn't have a medicalreason she can't use this, but she's not comfortabletouching yourself, ok?

which takes me back to themirror in the beginning of the lecture, i wouldencourage you to start looking at yourself and seeingwhat's there, ok? all right. i do have a storybehind this where one of my colleagues wasn't sureif she wanted to get pregnant and she came home one day, shewas using this particular method and she found thering on her dresser and she asked her husband, "whyis this ring on the dresser?"

he said, "the dog was walkingaround with it in her mouth and i thought thati was on hair ties, so i just put iton the dresser." and they had baby number three. ok, so you probably have heardabout the morning-after pill. it probably it's on--you see it in ads. this is somethingthat's an option for you. there is the category ofemergency contraception. there are three waysthat you can have

emergency contraception. one is this which isthe morning-after pill. one is the iud that theycan put in within five days of the unprotected intercourse and then one is takingsome pills. so, we carry this particularproduct in the health center. it's called next choice. you can get planb or next choice. you can get it over the counter.

up until a few months back,you had to ask the pharmacist about it and you hadto prove that you're at least 17 to get it. those rules have gone away. ok. but if you go to thepharmacy, you may be paying 40 or 50 dollars for this pill. you come to the healthcenter, you're going to pay 9. and a planned parenthood,i'm not sure if they charge anything, butyou can get it there, ok?

the idea behind this is if you're worried your birthcontrol method may fail, in other words, youscrewed up your schedule of taking your pills, youmissed a couple of days, that would be the time, ifyou're having intercourse, that you would have this. if the condom breaks orif there's a situation where you're having intercourseand you weren't planning on it and it just happened, then you'dwant to think about this option.

because i can tellyou, 40 or 50 dollars at rite aid is a lotcheaper than a pregnancy, ok? so this is somethingthat you can anticipate. if you just want to have thisin your emergency cabinet, in your cabinet or yourhome, your purse, whatever, you might want to havesomething stashed there in case somethinglike that happens. so this is meant to bean emergency option. it's not meant to be you'rehaving sex once a week

and you're goingto use this, ok? it's meant to be abackup to what you have. so the most critical thingis it's best to do it, take the medication assoon as the intercourse-- as close to the intercourseas you can, the one that was unprotected. but if you don't get it,you can go out to 120 hours. but really, the besttime is within 72 hours. the best time is within 72 hours

where you can get 89percent effective. what-- how this works? specifically, itdelays ovulation. that means that theegg won't be released. and then if you continueto have intercourse between the time you take thatpill and your next period, then you have to use birthcontrol in there as well, condoms, some othermethod as well. because we just said thatwe're delaying ovulation,

that doesn't mean thatanother egg isn't coming and you're going to get nailedon that intercourse, ok? so we talk about maleand female condoms. you probably know thatwe have latex condoms. if you have some irritation, either partner has someirritation after intercourse and there's somescratchiness or irritation, it might be you havea latex allergy. this is one product you canuse on the left hand part

of the screen, it'scalled avanti. you want to get moreof a different type of non-latex materialin having intercourse. then we have the femalecondom, and i'm going to show you whatthat looks like. it's called the reality condom. it comes packaged like this. and i would encourage you togo over to rite aid or cvs or whatever and look in theirbirth control area, you know,

their-- the contraceptive areaand check out the products. this is what realitycondom looks like. in real life, this iswhat you're going to see. this is a female condom. why would we wanta female condom? why would we need one? >> don't trust the guy. say that again. [ laughter ]

yeah, ok. so as he wassaying, you don't trust the guy to wear the condom, right? ok. so basically, a lot ofguys don't like to use condoms and they're going to bequite strong about that and the woman still feels likeshe wants to have intercourse with him, this givesthe woman control. she can say, "if we're goingto have sex, then we're going to use a condom that i have." ok? so the women needto feel empowered here

that they can protectthemselves. so it looks like this. the good thing about thisis that a man doesn't want to use a female-- a malecondom with a female condom, the two don't go together. it's one or the other, just because of thematerials and how they are. the thing of thisis, is that, again, you're going to see a circle.

you'll never think ofa taco the same now. you're going to fold it like ataco and you're going to put it up inside the vaginaand you're going to-- this is the target for the guys. ok? this is your target. so don't want to be oneither side of the sleeve, of this condom, becausethat defeats your purpose. this is where thepenis needs to go, ok? so once he ejaculates,it's caught in this area.

and then you just twistit and you'll pull it out. it's very flexible. sometimes when they'renew, they can-- you're only going to usethis once, by the way. and sometimes when they're new,they're going to-- it feels-- it might feel-- itmight be a little noisy, i'll just forewarnyou about that. there you go. it's only been touchedby my hands.

ok, so we worry about-- so we do have-- again,just if the women are-- if they worry they might havean allergy or an irritation from the latex condoms, you canswitch over to this reality, just to keep that in mind. i think they're 2 or 3dollars each for each type. so this is the diaphragm. the diaphragm comesin different sizes because women comein different sizes.

and if a woman gains orloses 10 or 15 pounds, she has to have this refitted. this requires to go into theclinic and have it fitted, and she needs to learnhow to put it in and out. but again, here you are, you have a round diskthat looks like this. you don't want a hole in it. because what happens ifyou put a hole in it, the sperm are goingto get in, right?

so we just thesewith holes in them so you don't walk out with them. they're not going todo you any good, ok? again, you're going tosqueeze like a taco. you're going to putit up inside. and what's it coveringwhen it's inside? what's that thing that lookslike-- feels like your nose? cervix, right. so it's covering the cervix.

you see this is anice barrier method. it goes in within a halfhour of intercourse. it stays in for six to eighthours after intercourse. if they have repeatedintercourse, then they have to put more spermicidal jellyin there and keep it in place. this is a good optionfor someone who doesn't see theirboyfriends very often. maybe he's at themilitary and he comes home and he's only going to be home amonth, this might be something.

if the woman can't takeany birth control pill or a hormonal-based method, shecould use something like this. but you have to, again, becomfortable touching yourself. ok. there you go. ok, the sponge is somethingyou can be over the counter. again, it works the same way. it's round and you wet it alittle bit with some fluid, like i think it's waterand it activates it, so it's spermicidal, and thenit will kill the sperm once the

sperm are in there. it's a one time useitem as well. you can go again to rite aid, look at all the differentpreparations. you can have suppositoriesand gels and foams, all those things, andthey're going to be available to you over the counter. so you don't have to see someonein the clinic to choose those. withdrawal.

what is withdrawal? [ inaudible remark ] what is it? some people use withdrawalas a method. and i heard the word here. >> pullout. the guy pulls out rightbefore he ejaculates. but we talked about thisin the group on wednesday and the guys admitit's pretty hard to do.

because it's such a splitsecond decision, right? so if the guy isready to ejaculate, sometimes it's really hardto pull out because you want to kind of finish it off inside. so it's not an-- it'snot an option, really, sometimes for some people. so if you know yourbody really well and you can do it, that's fine. but it's not full proof becausethe pre-cum, what some guys call

"magic juice", has sperm in it. ok, so the other thing thatyou can use is a calendar and taking your temperatureeveryday. i'm not going toencourage you to do that. if you want to learn about thatand how to do, we'll be happy to help you about thatin the health center. but generally, thatmethod is used for people who want to get pregnant. they want to knowwhen they're ovulating

and they're tryingto get pregnant. and again, it's nota full proof as well. but it is an available option. ok. so let's talkabout lubricants. and i mentioned to you and ikeep saying it, if you're going to get some irritation,that's something that could set youup for an sti. so we want to look atlubricants and we know that they can make sex morefun and it can be easier

if you're havingtrouble with lubrication. you have to have less friction because if you have morefriction, you're subject to micro-tears, andso you want something that reduces theevidence of micro-tears. hey guys, sit up. all right, so the problem is, is that when you havean interior lining, either your urethra or insidethe vaginal wall, you risk the--

your risk go up forgetting another sti, such as hiv transmissionand herpes. so let's look at someoptions in lubricants. we've got vaseline,vasenol, astroglide, johnson's baby oil,butter, reddi-wip. ok. so i will tell you-- whocan tell me why i'm crossing these off? yeah, ok. so, you know, it'sin the heat of the moment and you think, "oh my gosh, ineed something," and you run

to the kitchen and grab this. do not grab any of these. why don't we want to grab these? it increases infection. that's one thing. it can increase-- 'causeyou've got this sort of oil. the basic bottom lineis that it's oil-based and the oil willdamage the condom and the condom has ahigher risk of breaking.

that's why we don't use it. ok, so always use awater-based lubricant. we give away one in the healthcenter, it's called astroglide. it's a great water-basedlubricant, but there are others to try. so i would encourage toexperiment and check those out. reddi-wip is fun, i cantell you that, that's fun. but don't try to useit as a lubricant, ok? so a good idea, we want you tobe using condoms and we want you

to use them every timeyou have intercourse because it helps prevent asexually transmitted infection and a pregnancy. so we're going totake a condom break and let's talk about condoms. you probably are alreadypretty familiar with this, but i want to go overit and i'm going to ask for a male volunteer to come andhelp me show how this goes on. let's go over some ofthe finer points of--

let's go over the finer points. sit down. i didn't say yet. hold on. ok, so wehave the package. we have the packageand how do we know-- we want to make surethat the condoms that we use aren'tdamaged already, that they don't have holesin them already, right? ok. so how do i know itdoesn't have a hole in it?

[ inaudible remarks ] it's not open, yeah,that's true. but also you want to feel itbecause when their packaged, they have a littleair bubble in them. so if you feel that air bubblewhich i can feel up here, there's no hole in it. the other gentleman here saidthat you want to check the date. that's true. you want to make sureit's not expired.

so, this one is gooduntil 11/13. wow! so, next month. so-- by the way, we dogive away free condoms at the health center, so you could just walkin and pick them up. at the end of this presentation,you'll see some free condoms on the table that youcan help yourself to. ok. so, the expiration dateis good, the bubble is good. when i open it up, i do not wantto do this with my teeth, ok?

some people might be inclinedto want to do it with the teeth. don't do it because youcan put a hole in it. be careful with younails as well. you want to open it up so thatyou don't have a hole in it. ok, so the thing about thecondom is that we encourage you to use one that hasreservoir tip in it. so that gives you a littleextra space for the ejaculation. because there's a lot ofpressure when you ejaculate and the one-- the rounded tip,

they're more likelyto break, ok? so the reservoir tip is therefor a couple of reasons, but that's the main reason. you want to make sure thatyou're putting it on correctly. and then when youput the condom on, as soon as the penis is hard,that's when you put it on. you don't play arounda little while and then decide to put it on. because chances are,the playing goes on

and you forget thecondom, all right? ok. so what do guyscomplain about condoms? >> it doesn't feel good. yeah. decreases thesensitivity, right? so the option that youcan do with that is that you put a little ofthat lubricant i spoke about, the water-based lubricant, you put it in thelittle reservoir here. you put the lubricanton the shaft

to the penis when it's hard. your roll the penis down. you want to squeeze out the air, roll the condom downover the penis. and then you put morelubricant on the outside, ok. that increases the conductivity and the sensitivity isreported to be better. so that's an option. so you have somehomework this weekend.

ok. so, this is wherethe guy comes in. where is guy who's going tocome up and help with this? come on up here. what's your name? >> william. >> yeah. >> so william is here. why don't we start outby giving him a hand? [ applause ]

ok. so, we don'thave lubricant today, so we're just going to squeeze. when you put the condomon the hard penis, you're going squeezeit and then put it on and roll it all the way down. so what i'd like you to dois put your thumb inside. put your hand-- >> are you puttingit on my hand? >> i am.

>> all right. it feels really good, you guys. >> so the question for theladies is, is it too small? no. >> this one is. >> no. don't openup your hand here. ok. >> ok. >> that's pretty cool.

it's not cuttingoff circulation-- >> not yet. yeah, yeah, yeah. ok. so the other point iwant to make here too is that once the guyshas ejaculated and before he goes really soft,you want to put your fingers around the base of thepenis and pull out. either partner can do that. the reason you wantto do that is

because there's alittle ribbing here. and if it-- it can catch onthe outside of the partner and pull off and then thewhole plan has been defeated because it comes offinside the partner, ok? great. so, the other thing i say at this point isi tell the women that if you got somethingthis big coming at you, get out of town. here, hold on a second.

here you go. you might want some. >> yeah, that would be great. >> you want just thisor you want some-- >> no, that's fine. yeah. >> you're a good sport. >> thank you. >> so, william was a good sportso he gets a lunch at subway.

>> ok, thanks. [ noise ] ok, that kind of wraps up thepiece about birth control. are there any questions? anyone's brave enough to ask? >> if you're ready to go again,you can put a new one on, right? >> yeah. he asked ifyou're ready to go again, when you're ready to goagain, you put a new one on. yes. so one time use only.

and i would ask you to turn--pull it off, put a knot in it and toss it, ok, in the can. so we're going to goforward now and talk about sexually transmittedinfections. this is much more graphic. you're going to seereal clinical pictures. i'm just letting you know that. we do have over 20 differenttypes of stis out there, but i can only talk about a few.

i can't even coverhepatitis b which is important for all of you to know about. it's a sexually transmitted. i can't even speak about-- ican't even speak about hiv today because i'm really going to--not that does aren't important, they are important, butthey're just so much time to keep your attention, and soi'm going to hit the bigger ones for us right here today. so, one in two sexually activepersons will have a sexually

transmitted infectionby the time they're 25. that's 50 percent. again, it's every otherperson in this room. so those are prettysignificant statistics. women are more vulnerablethan men. why would that be? yeah, but why arethey're more vulnerable-- we're going to moveaway from pregnancy and just talk about an sti.

why are women morevulnerable than men in getting a sexuallytransmitted infection? more surface area. ok, anything else? hmm? no. i'm going to give you a hintthat it's an anatomical reason. she's inside. she's more internal, exactly. and so, she has this-- she'sa receptacle, quite frankly,

and he goes in andhe ejaculates, and whatever he ejaculatesbesides sperm is there. whatever is on hispenis is there and she's left to absorb it. he pulls out, moveson, she's got it for a few days beforeit moves on itself. i just want to make the point that a woman can start herperiod and she doesn't know it for a couple of days becauseit hasn't dropped down.

the flow hasn't come downfar enough for her to know. that's the same thing with this. you can be exposed toorganisms and not know it. so you want to askabout getting tested. this is really critical. if you are sexually active, youshould be testing for chlamydia to begin with, and thenthere maybe some other ones that we have to starttalking about. so, the risk factors forstis is sex in an early age.

what is the average ageof first intercourse? fifteen. average age, 15. fifteen, ok? and if we're going totalk about oral sex, what do you think the age is? it's young. we're hearing fourth graders. so when you're talking aboutoral sex, you're not talking about risk of pregnancy,but you are talking about--

you are talking about risk of sexually transmittedinfections, ok? multiple partners. the more times you have sexwith different partners, the more risk you have. the risks are going up, ok? i read a statistic where over alifetime women have 10 percent chance of gettingcervical cancer. but every time they have anew partner, it goes up by 10

or 15 percent witheach new partner. so it's somethingto be aware of. so you have multiplepartners, you're having sex at a young age, andit's unprotected. because when you're 14and 15 and 16 years old, you're not thinking about that. and you may not be thinkingabout it in your early 20s. but if you're having unprotectedsex, you have an exposure to organisms that you can't see.

now, i use the example of sex-- with having sex with thosewho've had sex with others. so, you're havingmultiple partners when you're havingsex with people. and the reason is becausewhen may has sex with kent and then kent goes onand has sex with chris, chris is actually havingsex with may and kent. and then when chris goeson and had sex with alex, alex is actually, on acellular, microscopic level,

alex is having sex withchris and may and kent. so whoever you're sleepingwith, you're sleeping with whoever they sleptwith and that person again. now, i intentionally left thenames chris and alex neutral or gender neutral, and sochris could be female or male, alex could be female or male. and so, we have bisexualindividuals. and so, if someoneis experimenting and they don't know, they'requestioning, they're not sure,

there can be thatbisexual exposure as well, so just to be aware of that. ok, so here's yournormal cervix. and now, we're going to seesomething a little different. so-- this is a normal cervix. it just looks a littlebit different. but i want to point out, thisis the opening, this is os, and this is again wherethe sperm goes in,

the baby comes out. you can see that the tissuesare a little bit different. when we do pap smears on women, we check for precancerouslesions. this is what we're checking. we take a little brushand we just, you know, go over that a littlebit with a brush. it's painless. we capture some cells thereand we look for changes.

when women are infectedwith the organism that causes cervical cancer, this is what we'repicking up right here, ok? so that's normal. you can see normal life reflex. there's no lesions there. there's nothing happening. here, it look-- it's immature. and so, you can see that thattissue is really vulnerable.

i mean you don't haveto be a clinician to see that this is really vulnerable. and so, if this person islike 12, 13, 14 years old and she's havingunprotected sex, you can see why shewould be more vulnerable for getting a sexuallytransmitted infection. now, a 22 and 24 and28-year old can have a cervix that looks like this too. just to be aware of that.

but i've made the pointbecause when you're young and you're developing, yourcervix is going to look like this and theneventually it goes away. this is the infected cervix. you can see it's red andit's kind of friable-looking. you know, it kind of lookslike it could bleed easily and it has a discharge,a pussy discharge. so chlamydia, whichyou may remember from the beginning slides,is a bacterial infection.

it is the most common bacterialinfection among the sexually transmitted infections,most common. it is in the college agepopulation like no other. it's the highest. it's the worse problem we havein your age group, 15 to 25. so, 80 percent of thewomen aren't aware that they have this infection, 50 percent of themen are unaware. the symptoms can include anabnormal vaginal discharge,

bleeding after intercourse, painful urination,and penile discharge. but remember, women are inside,they can have this infection and not know that they have it. with gonorrhea, that's theothers sexually transmitted infection that'sbased with bacteria. fifty percent of the womendon't know they have symptoms and 90 percent don't knowthat they have symptoms when it's a sore throat.

so we're going backto oral sex again and when you have oralsex, you are at risk for getting gonorrhea ifyou're not having condoms, using condoms for oral sex. ok. so on that note, ijust want you to know that we do give away flavoredcondoms on the health center. so we have banana and chocolateand strawberry and mint. so there's about fivedifferent flavors there for you. so you can stop inand pick them up, ok?

incidentally, i dohave a magnum up here. we give those away as well. but for the guys, i justwant you to know that a lot of this is partially marketingbecause these magnums are only 1 to 2 millimeters larger than theone i had up here on william, thickness of 1 to 2 millimeters,ok, or the diameter of it. ok, so i want to goback to oral sex. we do have a problemwith gonorrhea. it is approachingsuper bug status

which means we are running outof medications to treat it. it is a serious infection andit's something that we have to watch for and screen for. so when you have gonorrhea,you have some painful swelling. you can have burningwith urination. usually the guys will come inand they may have some tingling and we'll treat them right away. i will tell you ifa guy comes in and says something is reallydifferent, i'm having tingling

or burning sensationwhen i'm urinating, we will treat you right thereon the spot for chlamydia. most often, it's chlamydia. but a lot of times, chlamydiaand gonorrhea run together, so we'll test you for both. if it goes untreated,then the guy can get into urethral scarring anda painful epididymitis. that's where the tubesits on top of testes. that can get inflamedand infected.

and it can result in notbeing able to father a child. so that's somethingto be aware of. with women, it canmigrate up the cervix. it can go up into the uterusand then the fallopian tubes. and it can cause pelvicinflammatory disease and can result in infertility. it's something thatwe're very worried about in your population. so one thing aboutgonorrhea that's separate

from the chlamydia, it can goonto your brain, in your heart, and in to your joints. and i personally know someonethat it went into their joints and she ended up inthe hospital with it. so it is as serious infection. it makes you more susceptibleto hiv infection just because of the way itimpacts your system. if a woman were to givebirth while she had an active infection, she could pass iton to her child, her infant,

her newborn, and that couldresult into blindness. ok, so here are ourpictures now. this is the outside of a womanand you can see she's got sort of a fullness here that's red, that's an abscessthat's probably caused from either gonorrheaor chlamydia. and this is just thehyperpigmented woman. she has somethinga little different but it's along the same line.

this is the cervix. now this one looks different. this one kind of looksangry, don't you think? it's reddened, there'sdischarge from it. this is a pussy dischargeand this is the point where i tell the guys whenyou go in without a condom, the end of your penis is goingright into this discharge. and you're not feeling that. it just feels the same in there.

you're not going to know. ok. this is another discharge. again, here's the cervix opening and there's dischargeall around there. let's get the guysequal time here. this is a guy who hasa pussy discharge. it's something that youneed to be aware of. i can tell you this guy isgoing to be in the clinic because that's not normal.

ok. so when you have gonorrhea,chlamydia, we worry about woman in particular going on topelvic inflammatory disease. that's when the pelvicorgans get really congested, inflamed and uncomfortable. it can result in infertilityand ectopic pregnancy or chronic pelvic pain. this is very uncomfortable,when you can't sit and you can have an intercoursebecause it's too painful. this is pelvic inflammatorydisease.

this is normal, anormal fallopian tube. this is what it lookslike when it gets inflamed and swollen and uncomfortable. so what's an ectopic pregnancy? ok. so an ectopic pregnancy is when a pregnancy occursoutside what's normal. so remember what's normal isthat the egg goes down here, implants, and growsinto a fetus. when you have anectopic pregnancy,

that can happen where-- ifyou recall at the beginning of the lecture, isaid it's very narrow. and if you have scarring from ansti like gonorrhea or chlamydia, that scarring can cause theother thing conceptus to stop. and so as this conceptusis going down, the fertilized egg is goingdown here, it can stopped on a narrow part of the tubebecause of the scarring. and remember, it's just the sizeof a hair shaft in some places. so if it gets stopped andit's stuck and it can't move

but it's growing,what's going to happen? it's going to explode. it's going to rupture. and that's a surgicalemergency for the woman. she's going to be in the or. she's going to be having i thinkthis opened up and they're going to have to take out that-- that's not a viableproduct anymore, that conceptus is not goingto survive, it's done.

but then they're going totry to repair this tube to put it back together so thatshe can get pregnant another time in her life whenshe's ready for that, ok? so this is a surgical emergency. so, when you havean sti history, you have an increased risk ofgetting an ectopic pregnancy. increased pregnancyof ectopic pregnancy, you have an increased risk ofbeing sterile or infertile, not being able to conceive.

because if you blow up thisside, you may be only left with this side to get pregnant. so, we offer freechlamydia testing. it's a urine test atthe health center. it doesn't require an exam. you come in and say, "i justwant to do the sti testing," we will do it for you for free. you just can't pee for anhour before the test, ok. you did the test, we send it in.

if you come back positive,we're going to treat you at the health center for free. if your partner isa pcc student, we'll treat your pccstudent partner for free. if you turned out to be positivefor chlamydia, we're going to go on and test you forgonorrhea, syphilis and hiv. we do have an hiv counselor atthe health center on tuesdays and he does the oral test,so you get your results right at the time of theappointment, ok?

if you're not positive, butyou want to do the other test, then the tests are low cost, but you didn't get thosethrough us as well. we're not-- we worry aboutherpes, that's a virus. the one thing about chlamydiaand gonorrhea is pretty nice because we do have antibiotics. when you get in to viruseslike what we're going to talk about now, we don'thave treatment for that. we only have medications thatkind of can reduce the symptoms.

so you have herpes1 and 2, no cure. if you know someone who hasfever blisters on their mouth or cold sores, don't allowthem to go down on you, ok, because it can be transmittedto your genital area. and if you have that, beresponsible and don't go down on someone becauseyou can transmit it to their genital area, ok? if you-- now the thingis, is with oral sex and genital sex intermixed,the two can mix up.

so you can have genitalherpes at your mouth and you can have oralherpes in your genital area. the main thing about the virusis that it's stored in your skin and it's always shedding. as your dead skin flakesoff, so does the virus. so, although it's a less risk when you don't havethe active lesion, it is possible to get it. it's a much less risk.

but when you havean active lesion, you are shedding virusthat is communicable. this is what it lookslike in a man's penis. and you can see thatit's kind of a blister. this hurts. this guy would notbe in school today. it has its naturalprogression of what it does. it breaks up. they erode.

they become ulcers. and you're going to see whatit looks like on a woman when it becomes ulcerative. this is very painful. she would not be sittingin this class today either. ok. so you do not want-- -- to have exposure to this. and i didn't mention, but wedo have dental dams as well and they come in differentflavors and they come

in latex and non-latex. if you're having oralsex, you may want to have a dental barrier, ok. this is can be purchased. we have them at thehealth center. you can stop and then askfor them, they're there. but you need-- ifyou're having oral sex, you need to have a barrierbecause you're not going to know if someone's got aninfection with that or not.

they're not going to be talkingto you if they look like that. why do i have michaeldouglas up here? why do i have michael douglas? anybody? >> he's the man. >> huh? michael douglas, you may know, just separated from--what's her name? catherine zeta-jones, right?

but he was in the newsabout a year or so ago because he's beendiagnosed with throat cancer. and the underlying problemwith throat cancer is that it caused oftentimesmost likely from hpv, human papillomavirus, which isthe most common viral infection in the united states andi think in the world. so when we talk about thechances of you having an sti between now and 25, thisreally increases your chances because it's a viral infection.

it's called humanpapillomavirus. and there are over100 strains of it. but 40 of those differenttypes can cause-- come from a sexuallytransmitted infection, ok? of those 40 types, four inparticular are linked to cancer, cancer of the cervix, cancer ofthe penis, the anus, the vulva, the outside of awoman, and the throat. so we're seeing a bigincrease among the oral cancers and this is the underlyingproblem with it.

it's more noticeablein men right now. but i just saw an articlethe other day that said that by 2020, the year2020, throat cancer based on hpv will outpacecervical cancer in women. that's a pretty significantstatistic. so it's the mostcommon viral infection. you can get it skinto skin contact. so if you have warts on yourskin and you come in contact with someone, you canget warts that way too.

it's a virus. viruses are very common. we live with them all day long. but when they'regenitally-based, then we have to more concerned about that. you don't have todo it to get it. you just have intimate contacts. someone has got somewarts, you can get it too. ok, so a condom onlyprovides some protection

because they can breakand you can have exposure that way to it. and the condoms areonly going to cover that area that it covers. so the whole skin folds andthe area of skins around it, the skin around is not going toprevent you from getting hpv. so we worry about 6 and 11. this is a low risk hpv. it causes genital warts.

most people have these notknow that they have them. they can be pink or gray. they can be raised,flat, single, clustered, they look like cauliflowers. so between tacos andcauliflowers, you're not going to have-- you're going to havea different reference now, ok? so they can call-- it causesitchiness and irritation, so you might-- thatmight be your first clue that you have it.

sometimes women havea vaginal itching area and they think theyhave a yeast infection, this is actually what'san underlying problem. this is what it lookslike on a woman. now this is a differentcase but i-- when i said to you that youhave skin to skin contact, you can also have what we call-- also have what wecall autoinoculation. in other words, you cangive it to yourself.

so this woman probablygave it to herself and that when her legs came togetherto walk, she crossed over. and that's why you seethe two lines here. you can see there's a rowhere and there's a row here. and then there's little spotsup in here, all this area here. these are all little venerealwarts or genital warts. on the man, it looks alittle bit different. now he can look like this. and i've actually seen a caseon a man where he came in

and the best way i candescribe it to you is that his entire scrotumwas covered with warts. and it looked like someone hadlopped off the top of an eraser from a pencil and justpasted it on his scrotum. and it was full. and i said, "how long hasyour scrotum look like this?" and he said, "look like what?" he had no idea thatit was different. it was another guywho wasn't tuned in.

now, the place wherei found this fellow where i was practicing atthat time was a chemical dependency program. so it's possible thathe was, you know, under chemical influence a lot and just wasn't payingattention. but you need-- that'swhy you need to pay attention to your body. guys could miss somethinglike this, ok?

that is infectiousthough, it is communicable. so the main thing is--so that's the low risk. so the low risk numbers, 6and 11, cause genital warts. then we worry more aswell about 16 and 18. these are high risk. you can have no symptoms. we might pick it up ona pap smear with women. she can have bleedingor spotting in between her periodsor after intercourse.

this is the cause of thiscancers, so the cervix, the anus, the penis, thevagina, the head and neck. so 16 and 18 are the causes forthroat cancer in men as well. this is what it looks likewhen you look at it at someone and you're lookingat a cervix again. you see this area, if i wereto take a little wooden spatula and try to scrape that off,we couldn't scrape it off. that's what it looks like. so guys, you're notgoing to feel this.

i'm telling you,you won't feel this. the other thing i wantto point out for those of you who are smokers. smoking increases theproliferation of warts. and they had foundpepsinogens in this mucosa. it's a co-factor withhiv-- hpv infection. so when women havecervical cancer, one of the things they're going to ask them is, "areyou smoker?"

so if you're a smoker, you're increasing your chanceshere of having a problem. >> like cigarettes. >> cigarettes. so when we're smokingcigarettes, we're talking about the carcinogensthat are made in. and the jury is still out onthose e-cigarettes, by the way. this is what it lookslike when it gets to be very proliferative, ok?

this is pretty significant. it's up in here as well. and then for the men,we'll give you equal time. so these are allwarts around here. this is perianal warts. so leave the littlelight going on there because i encourage youleave the lights on, ok? you want to check yourpartners for clues. check your partnersfor any discharge

or any little skin tags. ok, so the good thing--the good news here-- the good news is that we havea vaccine that prevent these. sign up right away, yeah. ok. so basically, we'llworry about this for? there's a vaccine on themarket called gardasil. it's been out since 2006. and it is recommend thatyou take it that we start it around age 11 and 12for girls specifically,

but men are encouragedto get it as well. and particularly up around age19, 20, they should have it. i'm going to ask a question, if we find on pap smear womanis infected with one of these, number 6 or number 16,would you encourage her to get the vaccineanyway or say, "no, we're not going to do that." get the vaccine anyway. because she may beinfected with 16

but we can help herprotect her against 6, 11, and 18 as well, ok? so please know that if you donot have an insurance right now, that at the healthcenter, you can come and get this vaccine for free. it is worth 400 dollars. if you had to pay the outsideprice, go out through a clinic and pay for it, it's aseries of three shots. you'll be paying closeto 400 dollars for it.

but if you do not have insurancecurrently, you can come to the health center underour patient assistance program where we can givethis to you for free. i strongly encourage everywoman and every men in here, if you're sexuallyactive, even if you're not, get started on thisand get protected because that ends at age 26, ok? so the take home messageis to be informed, get yourself tested,and get vaccinated.

you've had a lot ofinformation here today. i can't possibly go overwhat more there is there but you certainly can comein for more information. you can come in onindividual counseling. so hold on a second,i'm going to ask you all to remain seated please'cause i want to go through these lastfinal questions. this is for the men and thewomen who have the clickers. eighty percent of thewomen and 50 percent

of the men do not have symptoms when they're infectedwith chlamydia. so is that true or false? just point and click. point and you clickone more time. so the answer is true. so there's a differencein opinion there. human papillomavirusis 16 and 18. i'm going to ask you all tobe quiet, if you please can,

'cause i need to get thisinformation here at the front. and i'm open to any questionsthat you may have as well. so human papillomaviruses 16and 18 cause cervical cancer i'm going to need all theclickers up here in the front when you're downwith them as well. so good. what is a backup method that current birth controlmethod may not-- may fail? i want to make anannouncement as well. ms. tran [assumedspelling] is going

to be stamping your passportsfor you, so please don't leave if you need thatpassport stamped. good answer. how many sexual partners haveyou had in the last year? i ask you to stay, ihave few more questions. yeah, you will, whenyou're done with it please. ok, there are somesignificant numbers here. i just want to say thatthis group is higher for a no partnersin the last year

than the other previous groups. however, there are more amongthe three, four and five. so i would encourage thosewho fall in that category to definitely come in andget some testing done. this is what a normal pcc or anaverage pcc student looks like. they've had 30 percent aboutno partners or one partner and then a lower amount. so this group ishigher for number of activities orsexual partners.

if you're wondering about yourrelationship if it's healthy or not, you certainly can get--go to this i need your feedback, if youjust answer this question. did the presenter help youidentify a specific health risk or behavior? if you could change, would youprotect or promote your health. in which category that thehealth risk behavior belong? was it in the availabilityof a lab test, risk reduction behaviors,health counseling,

or birth control education? thank you. you could just point up hereand press for me please. and one final question. on a scale of 1, not interested,to 5, very interested. how committed are you in changing your health riskbehavior and in protecting and promoting your health? great. if you just dropthe clickers up here,

that'll be greatand help yourself to the stuff in the back.

Jumat, 05 Mei 2017

penis surgery

your doctor has recommended that you undergoa trans urethral resection of the prostate - or turp. but what exactly does that mean? the prostate gland is a walnut-sized organthat is part of your reproductive system. it provides some of the fluid contained insemen. the prostate is located just under the bladderand behind the testicles.

penis surgery

penis surgery, the urethra -- a hollow tube that carriesboth urine and semen to the penis -- passes through the prostate. in some men, the prostate gland becomes enlarged.symptoms of an enlarged prostate include: patient education* a full bladder feeling even when the bladder

is empty * pain when urinating * weak urinary stream * infertility * and sexual dysfunction. to relieve you of your symptoms, your doctorfeels that you would benefit from a surgical procedure called turp. turp is designed to relieve symptoms by reducingthe size of the prostate. it is also a diagnostic procedure. tissueremoved during a resection of the prostate

or turp is routinely screened for the presenceof cancer. so make sure that you ask your doctor to carefullyexplain the reasons behind this recommendation. your doctor will then lift your penis upward. a well-lubricated instrument called a resectoscopeis then gently inserted into the urethra. when the resectoscope reaches the back ofthe penis, your doctor will pull the penis downward in order to create a straight pathinto the prostate. using this tool, your doctor will then scrapeexcess tissue from the prostate, restoring it to its normal size.

tissue removed from the prostate may be senta laboratory for analysis. when the surgery is complete, your doctorwill remove the resectoscope. your doctor will probably ask you to wear a temporaryfoley catheter. a foley catheter is a narrow tube insertedthrough your urethra and into your bladder. the catheter is connected to a bag that isattached to your leg by a strap. while the foley catheter is in place, urine will passfrom your bladder into the bag. you will not need to urinate into a toilet. the nurse will show you how to change thebag when it is full. an appointment will be made for you to return to the doctor's officein a couple of days to have the catheter removed.

as soon as the anesthesia wears off and youfeel comfortable, you'll be allowed to leave.

Kamis, 04 Mei 2017

penile discharge


(typing) - hey! okay, so i got two different types of tile that we can choose from,and i think this one's nice. it's a little bit more simple.


masturbating, and then this-- - no, i told you, you do the tiles. i don't care. i don't have an opinion andi have to get this pitch done

for adventure baby. i don't even know what i'm doing. - okay.- okay? - please, please, please, please. take this. take this away. - alright, i'll figure it out. - thank you. - i'm sorry.

(keyboard clacking) jason? - what? - have you been using my ipad? - your ipad? - oh, no. you've been going to porn sites. - no, no i haven't. - do not masturbate with my ipad, jason.

and you're busy. oh, yeah, you're so busy. you're busy masturbating with my ipad. that's how busy you are. - the internet is so fast on there. i'm sorry. - jason, why are youmasturbating anyway, huh? hello, i'm open for business. - yeah.

- and you look great. i just... you know, we've been gettingalong so well lately. i don't want to ruin the friendship. (cymbal tapping) - hey. - (woman) hey there. - oooo! whoa! whoa, look at that. lookin' good. that's theold...that's the old nighty. that's the little action nighty.

- (woman) yes. - yep. - we can do it tonight. - you know what? i really, i really... i would love to, it's just... can i be honest? - of course. what? - you won't tell anyone? - who am i gonna tell?

- okay. i've just been like... i'm really bumming outabout my penis lately. - it's really small. - no it's not. it really isn't. - no it''s...- it's fine. - i stand in the mirror andi'm like, what's going on? it's so small. it's just not...and it's not fun. it's not fun for me having a small penis.

it's like, it's likehaving someone in your band that isn't good. you know? it's like... it just ruins all of it. - have you been watching too much porn? - i have been watching a lot of porn. - how much would you sayyou've been masterbating? - like three or four everyday. is that a lot?

- yeah. that is a lot. - that's a lot. - well hey, got no problem in that area. lot of guys have problems. not me. - dad! it's me. hello! jason can you come in here please? i don't under...- (jason) what?!

- can you come in hereand help with the...? i don't under...- (jason) the what? - with the facetime on the i... i don't understand if it's work... dad, hi! - i can hear you but i can't see you. where are you? - (jason) hold on. - okay look for the camera guys.

- hold on. - i see...hi. - hi. - i see you. that... - is that you live? i mean it's not a video? this is really you now, live? - yes! you're talking to me right now. what kind of ques...

what are you... can you hear me? - you know, we went to a party today and we really had a great time. - jason we thought about you. there was a clown. he was fabulous but you would have been better. - yeah, you know, maybe jason you should think about doing some clowning

at some parties for kids. you know, you've giventhis comedy thing a shot but let's get real, it's not... i don't think it's reallyworking out for you. maybe you should try clowning.- i, i don't want to be a party clown joe.- no he's... i don't want to be.- stop, stop, stop. that's not what i wantto do with my life. so... - just stop. just stop.

dad he's not gonna be a clown alright? just enough with the clown? - i'm not a clown. - he doesn't...he doesn't even know how to make the balloon animals. there's like... no, he's not a clown. - it's not the same thing. a stand up is not thesame thing as a clown.

i know that you think that it is. - wait, just stop. j,j. just stop, just stop. - are you sure this is you live? we're talking live? real time? (jazz music) - (jason) oh my god. okay. okay here we go. you ready?

- yeah, yeah. - are you ready? - yeah! - okay.- okay, jason... - (jason) oh god that's it.- you're like... - (jason) oh god that's good. oh wow. - (jason) ugh! - what?! - ugh! oooo god! whooo!

oh my god baby! oh mygod that's good! whoo! oh my god. - that was it? - you're so good. is that not good? - no that wasn't good. that was weird and aweful. - i'm sorry, i'm sorry. you know what it is? you are so hot.

it's, it's... it's a compliment. you're so, you're so hot. you know what? you're the real thingand no more porn for me. - alright well... i guess thanks for the compliment. - you're welcome. i love you.

- yeah... i'm gonna just...i'mgonna go to the bathroom. - okay. oh you know what i would love right now? doritos. - (gasp) i think i hear her. listen mom, i'm gonna go get her. - go, go ahead! go get the baby, we want to see her!

- so just don't disconnect cause i don't want to gothrough that again okay? (moans) - what's going on? - i don't know. what...what is that? what are we seeing? (screams) - (woman) yes! yes!

- (gasp) oh my god! - no wonder he doesn't want to get a job! he sits around the housejerking off all day! - oh my god! oh no!- (woman) yes! oh god, oh god! - j? (knocks) - are you in there?

do you have my i-pad? - oh my god. - mom? are you here? got disconnected. come here char. (band music)

Rabu, 03 Mei 2017

late ovulation

my bbt is up and down after ovulation. i cannothelp but wonder what is wrong. it normally does go up after ovulation. it is going up and back down. it normally goes up a third to two thirdsof a degree after ovulation. it typically goes down around the time your period starts.

late ovulation

late ovulation, unless you’re pregnant. and unless you are too active when you takeyour basal body temperature, so the reading spikes up that day. i know it spikes if you get up and run aroundto get the thermometer.

the basal body temperature can spike too,if you had restless sleep. i’d have to ask my husband if my tossingand turning kept him up. and you could see the bbt readings go up andstay up if you’ve started sleeping under an electric blanket. ditto if you’re sleepingin longer under thick blankets. i’m not using an electric blanket. it will go up if you have a fever. if i was sick, i would not bother trackingmy basal temperature. thyroid problems can make you tired and havea lowered basal body temperature too. thyroid problems would not make it fluctuatea lot.

you’ll get variation if you check the bodytemperature different ways. speaking of which, rectal is the most accurate method. i do not even want to stick a thermometerup a baby’s butt, much less my own. you’ll get variation in the readings ifyou take them the same way but at different times. pick on early morning time and checkit the same way every time. what if that does not eliminate the variation? make sure you are using a basal body temperaturethermometer that can pick up the tenth of a degree bbt charts are supposed to track,instead of plus or minus half a degree some thermometers do.

it is a basal thermometer. some women do not have a basal body temperaturespike or it is only a tenth of a degree, something that you hardly even notice. i do typically see a spike around ovulationbut see other peaks too. what else could explain the variations? staying up too late to party and enjoyingtoo much alcohol. then i won’t get accurate readings on thenights i’m most likely to get pregnant. if you had consistent readings that suddenlyshifted and stayed shifted, the solution is probably getting a new basal thermometer.

or using a different method to track my fertility. that’s why they sell ovulation tests insix packs and teach cervical mucus readings. i’d rather do the bbt checks rectally.

intercourse positions

sex positions

Selasa, 02 Mei 2017

elocon cream

mometasone is a prescription medication usedto treat asthma, allergies, and skin conditions. mometasone is in a class of medications calledcorticosteroids. it works by decreasing swelling and irritation in the airways to allow foreasier breathing. mometasone comes in several forms, including an inhaler, a nasal spray,a cream, a lotion, and an ointment. the nasal spray and inhaler are used once or twice daily.mometasone cream, lotion, and ointment are

elocon cream

elocon cream, applied to the skin, usually once daily. commonside effects include headaches, viral infections, sore throat, and nosebleeds. for more informationon this medication and all other medications, explore the rxwiki encyclopedia on the webor on your mobile device.

dick burning

hey, what's up? i'm chris. welcome to hp workbench. i'm going to show you how to make an encrypted, password protected cd or dvd using cyberlink power2go. now the same process is used to make a regular unprotected disk so if you're just looking to how to make a data disk you're still in the right place. as always this is part of our series of videos on how to burn cds and dvds.

dick burning

dick burning, now make sure to check out our video on getting started with burning if you need that. today i'm going to show you how to use power2go. i'm going to show you how to add files and arrange them on a disk. i'm going to show you how to choose encryption or not and how to burn a disk

and finally how to view the encrypted files when the disk is finished. let's go check this out on my hp touch smart pc. cyber link power2go is a disk burning software that comes on some hp touch smart and hp pavilions. power2go is part of cyber link's dvd suite deluxe so if you got suite deluxe go ahead and open up that. i'm going to click on the data disk tab. now right here is where you choose whether you're going to make a cd or dvd. the process is the same for both of them. today i'm going to use a dvd. now we're using power2go's version 6. in earlier versions you'd have to choose right here whether you're going to make it an encrypted disk or not but with version 6 you can actually add encrypted files and regular files on the disk.

you don't have to choose right here, you can make that decision later on down the road when you're adding files. let's go ahead and select data dvd. and here you go. this s power2go. now the upper window right up here is where you're going to navigate the files on your pc and the lower window here is where you arrange everything you want on your disk. all right, so what you're going to do is select the files and the folders you want and then drag them right down here into the lower section. now if you're just making a regular data disk this is all you need to know. if you want to have encrypted files you're going to select the secured folder button right here. it's going to ask you for a password.

now what this does is it creates a space on your disk to protect your files with a 128 bit encryption. you going to want to go ahead and insert the password and don't forget this password, okay? because you're not going to be able to view your encrypted files if you don't have the password. let me tell you something. once you burn the cd you can't go back and find it and you can't change it. so remember your password. another thing is if you select the hide the file names option, like that, it's going to take the files that you want encrypted and people won't even be able to read the file names. go ahead and click ok. now look at that. we've created a file folder for our encrypted files. now check this out. we've got two different file folders here going on so what

we're going to want to do is put our secret stuff right down here into the top red folder, just like that, and stuff we're not really worried about being encrypted, just regular files, you're just going to go ahead and move that right down here to the bottom. okay, so å¯ a couple of things about some little tabs up here. what you're going to want to do is if you want to create a new folder just go ahead and hit this button here and add a new folder and boom! you got a new folder in your disk. now if you decide you don't want some stuff on there all you got to do is select it and hit remove, and they're gone. now if you decide you want to start all over again and you need a blank canvass,

just hit clear all data, right there, and look at that. all clear, good to go. okay, let me show you another thing. i'm going to go ahead and select all these files here and bring them on down. now you see this bar here at the bottom, this lets me know how much room these files are taken up on this disk and tells me how much room i have left to add more files. okay, once you have the disk the way you want it, you're ready to burn. so go ahead and hit the burn now button. that's going to give you a couple of options here. for example you can lower your burner speed if that helps your burner

and you can adjust the number of copies you're going to make. we're going to go ahead and hit burn. it's going to ask you to insert a disk, a blank disk if you don't have one in there already. like i said earlier i'm going to use a dvd. and put that in. all right, there you go. you've got a burned data disk that's secure. so what do you do if you want to see these encrypted files? well, i'm going to show you how to do that. i'm just going to go ahead and insert the dvd back inside and when power2go burned this dvd it installed cyber link security browser on it so when this window pops up you going to want to go ahead and run that security browser.

that's going to ask you to insert something that i told you about earlier, the password. so don't forget your password or you're not going to be able to see your encrypted files. i'm going to run the security browser like i said and there you go, you got another password. okay. there we go. let's open this up. top secret files. now if someone's looking through windows explorer they're going to be able to see the files and the file names but they're not going to be able to access them. now if you selected the hide the file names and they're looking through windows what they're going to see is stuff like this right here. now they'll be able to see that there's files but they won't be able to read the file name.

so there you go. now you know how to make your own data disk and make it secure. if you got any questions at all visit us at the forum at as always i'm chris. thanks for stopping by hp workbench.

Senin, 01 Mei 2017


thank you for tuning into my video i'm going to talk about fluconazole. fluconazole is a pharmaceutical antifungaldrug. it's also known by the name of diflucan. fluconazole is also present in a vaginal creamcalled canesten that many women tend to use. i've seen many patients over the years who'vetaken diflucan. some with reasonably good success, but in most case, the drug has beentaken recurrently with very, very poor long-term


canesten, results.the best result you're going to get from any pharmaceutical drug usually is the very firsttime you take it. the body's not used to the drug. it will have a powerful effect and givethe desired result. but then what happens is the drug is discontinued, so then the symptomscome back, and the drug is used again and

again and again. and eventually, the bodybuilds resistance to diflucan. the resistance is well documented.i've seen some patients who take this drug weekly or monthly for years on end with badresults. and in many cases, they end up with significant side effects, particularly hepaticor liver side effects because diflucan affects phase ii or the glucoronidation pathway ofthe liver and it can make a person quite nauseous or sick. they can get skin reactions. theycan get headaches. they can get insomnia. they can get a whole range of different sideeffects from diflucan. i've got a pharmaceutical drug guide hereand i'm going to read out some of the common side effects of diflucan or fluconazole. sideeffects include gastrointestinal upset, headaches,

elevated liver function test, abnormal vision,skin odor, skin rashes, hot flashes, weakness, thirst, shaking in the body, polyuria, whichmeans urinating a lot, renal pain or pain in the lower pain, kidney pain, dizziness,seizures, skin itching, sweating, fevers, drug eruptions, more skin rashes, sleepingdisturbances and insomnia, nervousness, pain, female sexual dysfunction, menstrual disorders,respiratory disorders, deafness, heartburn, high blood pressure, liver damage. why thehell would you want to take a drug that creates all these problems just to give you some temporaryrelief from a vaginal yeast infection or some kind of a yeast infection you might have?there are natural ways you can get on top of these infections without resorting to drugs.have a look at for some

natural solutions. if you're thinking aboutan antifungal drug and you want to get some results but don't want the side effects withit, have a look at the product i developed called canxida. it's going to be more powerfulthan fluconazole. you don't need to take it for years on end. you're not going to getall of these side effects that i've just read out here. it's certainly worth a shot.think about it. if you're going to take fluconazole, take it once, but don't take it recurrently.there's no point in it. you're wasting your time doing that. you're only going to getdrug resistance and also liver toxicity from taking it.i hope that answers a frequently asked question i get on this particular drug fluconazole.thank you for tuning in.

burning lips

>> so the company that makes the e.o.s. balm lip gloss, you know the little eggs that have tons of chapstick. harvey: this is the one that

burning lips

burning lips, like kim kardashian -- >> everyone. >> hayden panettiere. >> britney spears.

>> they tout it. >> i give them out as christmas presents. >> there has been a class action lawsuit filed because some women have really bad reactions to it. harvey: like what? >> weird chapped lips, like burning lips and all of these

like bumps. the company is denying it. >> how are they proving it's the chapstick? >> the woman said she went to the store, put some on and her lips within hours started flaking and bleeding. >> so she put more on?

>> she said my lips felt like sandpaper so i tried to put more on. harvey: the operative word is moron. [laughter]

uk car hire to drive in europe

driving test uk - the short notice driving test specialist hello. i'm charlie. in this video i'm going to show you how to exchang...