Dr. Dr.Rohit Physician/family physician

Masturbation: What's the Definition?

Masturbation is one of the most popular pastimes of people, especially men. While various surveys and studies have turned up differing results, it's safe to say that it is the rare male who does not engage in masturbation at least occasionally. And if website traffic statistics for porn sites are to be believed, most men masturbate with considerable frequency. And why not? Few things are as fun as masturbation or require as little equipment; basically, it can be enjoyed anytime and anywhere (although it's best to limit that "anywhere" part to non-public places). And since men who ejaculate more often have a lowered chance of prostate cancer, there's even a penis health benefit to the activity. But when two people are talking about masturbation, can they be sure they are using the same definition? The answer might be surprising.

Classic

Naturally, there are some instances where the definition is not really in doubt. It's hard to believe that anyone would disagree that the following scenario doesn't fit the definition of masturbation: A man is alone in a room with his penis exposed. He has an erection and has wrapped one of his hands around that erection so that he is gripping it fairly tightly. He moves his hand up and down the penis until he reaches a point where he ejaculates semen.

That's a pretty classic definition, and one that would likely be universally recognized as masturbation. But suppose that scenario was changed slightly. Instead of stroking himself until he ejaculates, let's say the man stops before achieving that release. Is it still masturbation? There are some who would argue that it's not.

Other scenarios

Following are a number of other scenarios that some people would believe constitute masturbation, but which some others might not:

- A man has an erection. He exposes his penis, then lies face down on a bed and begins thrusting his hips back and forth against the mattress and sheets. He continues doing so, over and over, until he ejaculates.

Masturbation? Not to someone who believes that masturbation involves manual stimulation of the penis by one's own hand or hands.

- A man has an erection but keeps it tucked inside his pants. He rubs his penis through his pants until he ejaculates.

There's manual stimulation by hand here, but the hand isn't actually touching the penis; it's touching the fabric of the pants - and therefore some would disqualify it as masturbation.

- A very limber man is naked and sporting an erection. He somehow contorts his body into a twisted shape such that his head is in contact with his penis. Opening his mouth, he is able to suck on his own penis until he ejaculates.

Is autofellatio masturbation? To some yes, but to others it isn't; it is "simply" oral sex with oneself instead of with another person.

- To bring relief to his insistent erection, a man inserts it into a tube with an opening resembling a vagina and thrusts it in and out of the tube until he achieves orgasm.

As with autofellatio, some people would argue that this kind of sex toy penetration is not masturbation; it lacks the direct application of the hand to the penis.

- Inserting and withdrawing a phallic-shaped object in his anus, a man achieves ejaculation from stimulating his prostate but not his penis.

Again, with no direct manual stimulation of the penis, this would not be considered masturbation by some.

- A woman strokes a man's penis with her hand until he ejaculates.

To some people, masturbation is restricted one person stimulating themselves and no one else.

Whether a person considers any, some or all of the scenarios above to be a definition of masturbation, it's worth remembering that being too enthusiastic in self-handling can lead to a raw and sore penis. Regular use of a superior penis health crème (health professionals recommend Man1 Man Oil, which is clinically proven mild and safe for skin) can help. Choose one with moisturizing and soothing agents like Shea butter and vitamin E to help ease the soreness. And find one with L-carnitine, because rough handling often de-sensitizes the penis. L-carnitine's neuroprotective properties can help restore lost sensation.

Dr. Sharmila majumdar

Sexual dysfunction is broadly defined as the inability to fully enjoy sexual intercourse. 

The disorder must be deemed to have caused significant distress. In addition to the existing specifiers of lifelong vs acquired

Dengvaxia - first vaccine against dengue

Dengvaxia is a vaccine used to help protect adult or children against dengue disease caused by dengue virus serotypes 1, 2, 3 and 4. Dengvaxia is given to adults, adolescents and children 9 through 45 years of age living in endemic areas.

Read more:

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Full prescribing info - dengvaxia

Contents

Dengue tetravalent vaccine (live, attenuated).

Indications / uses

Dengvaxia is a vaccine used to help protect adult or children against dengue disease caused by dengue virus serotypes 1, 2, 3 and 4. Dengvaxia is given to adults, adolescents and children 9 through 45 years of age living in endemic areas.

Dosage / direction for use

The patient will receive 3 injections of 0.5 ml each at 6-month intervals.

The first injection will occur at the chosen or scheduled date; the second injection, 6 months after the first injection; and the third injection, 6 months after the second injection. Dengvaxia should be used according to the local vaccination schedule.

If the patient forgot an injection of dengvaxia: if the patient missed a scheduled injection, the physician will decide when to give the missed injection.

It is important that the patient follows the instructions of the physician, pharmacist or nurse regarding return visits for the follow-up injection. If the patient forgets or is not able to go back to the physician, pharmacist or nurse at the scheduled time, ask the physician, pharmacist or nurse for advice.

Administration: dengvaxia is given by the physician or nurse as an injection underneath the skin (subcutaneous route) in the upper arm.

Contraindications

Do not use dengvaxia if the patient is allergic (hypertensive) to the active substances or any of the other ingredients of dengvaxia listed in description (see description); has developed an allergic reaction after prior administration of dengvaxia. Signs of an allergic reaction may include an itchy rash, shortness of breath and swelling of the face and tongue; is suffering from a disease with mild to high fever or acute disease. In this case, the physician will postpone the administration of dengvaxia until the patient has recovered; has a weakened immune system, for example due to a genetic defect, hiv infection or therapies that affect the immune system (for example, high-dose corticosteroids or chemotherapy); is pregnant; is breastfeeding.

Use in pregnancy lactation: dengvaxia must not be given to pregnant or breastfeeding women.

If the patient is of child-bearing stage, the patient should take the necessary precautions to avoid pregnancy for 1 month following administration of dengvaxia; is pregnant or breastfeeding, the patient thinks may be pregnant or is planning to have a baby, ask the physician, pharmacist or nurse for advice before receiving dengvaxia.

Special precautions

Inform the physician, pharmacist or nurse before receiving dengvaxia if the patient is taking an immunosuppressive treatment (prednisone or equivalent to 20 mg or 2 mg/kg for 2 weeks or more). The physician will postpone administration of dengvaxia until 4 weeks after the treatment is discontinued; has experienced any health problems after prior administration of any vaccines. The physician will carefully consider the risks and benefits of vaccination.

As with all vaccines, dengvaxia may not protect 100% of persons who have been vaccinated. Vaccination with dengvaxia is not a substitute for protection against mosquito bites. The patient should take appropriate precautions to prevent mosquito bites, including the use of repellents, adequate clothing, and mosquito nets.

Fainting, sometimes accompanied by falling, can occur (mostly in adolescents) following, or even before, any injection with a needle. Therefore inform the physician, pharmacist or nurse if the patient fainted with a prior injection.

Adults above 45 years of age: adults above 45 years of age should not receive the vaccine.

Driving and using machines: no data are available on the effects of dengvaxia on the ability to drive or use machines.

Use in children: children less than 9 years of age should not receive the vaccine.

Side effects

Like all medicines, dengvaxia can cause side effects, although not all patients get them.

Serious allergic reactions: if any of these symptoms occur after leaving the place where the patient received an injection, consult a physician immediately: difficulty in breathing, blueness of the tongue or lips, a rash, swelling of the face or throat, low blood pressure causing dizziness or collapse.

When these signs and symptoms occur they usually develop quickly after the injection is given and while the patient is still in clinic or physician's surgery.

Serious allergic reactions are very rare (may affect up to 1 in 10, 000 people), after receiving any vaccine.

Other side effects: the following side effects were reported during clinical studies in children, adolescents and adults (from 9 to and including 60 years of age). Most of the reported side effects occurred within 3 days after the injection of the vaccine: very common (may affect more than 1 user in 10): headache, muscle pain (myalgia), generally feeling unwell (malaise), feeling of weakness (asthenia), injection site pain, fever.

Common (may affect up to 1 user in 10): injection site reactions: redness (erythema), bruising (hematoma), swelling, and itching (pruritus).

Uncommon (may affect up to 1 user in 100): infections of the upper respiratory tract, dizziness, sore throat (oropharyngeal pain), cough, runny nose (rhinorrhea), nausea, skin eruption (rash), neck pain, hardening of skin at the injection site (injection site induration).

Additional side effects in adults (from 18 to and including 60 years of age): uncommon (may affect up to 1 user in 100): swollen glands (lymphadenopathy), migraine, joint pain (arthralgia), flu-like symptoms (influenza-like illness).

Additional side effects in children and adolescents (from 9 to and including 17 years of age: uncommon (may affect up to 1 user in 100): itchy rash (urticaria).

Reporting of side effects or any suspected adverse event: if the patient experiences any side effects after vaccination, advised to seek immediate medical attention.

By reporting side effects, it can help provide more information on the safety of the vaccine.

Click to view adr monitoring form

Interactions

Using other medicines and dengvaxia: dengvaxia may not have an optimal effect if it used at the same time as medicines that suppress the immune system such as corticosteroids or chemotherapy.

Inform the physician, pharmacist or nurse if the patient is taking or has recently taken any other vaccines or any other medicines, including medicines obtained without a prescription.

Caution for usage

Before administering any biological, the person responsible for administration must take all precautions to prevent allergic or other reactions. As with all injectable vaccines, appropriate medical treatment and supervision must always be readily available in the event of an anaphylactic reaction following the administration of dengvaxia.

Epinephrine (1: 1000) and other appropriate agents used to control immediate allergic reactions must be available to treat unexpected events such as anaphylaxis.

Dengvaxia must not be mixed with other medicinal products in the same syringe.

Dengvaxia must not be administered by intravascular injection under any circumstances.

Syncope (fainting) can occur following, or even before, any vaccination as a psychogenic response to injection with a needle. Procedures should be in place to prevent injury from falling and to manage syncopal reactions.

Separate syringes and needles, separate injection sites and preferably separate limbs must be used if any other vaccine (s) or medicinal product (s) is/are concomitantly administered.

Dengvaxia is reconstituted by transferring all the solvent (0.4% sodium chloride solution) provided in the blue-labeled pre-filled syringe into the vial of freeze dried powder with a yellowish green flip off cap. The pre-filled syringe is fitted with a sterile needle for this transfer. The vial is then gently swirled. After complete dissolution, a 0.5 ml dose of reconstituted suspension is withdrawn into the same syringe. For injection, the syringe should be fitted with the new sterile needle.

The suspension should be visually inspected prior to administration. After reconstitution, dengvaxia is clear, colorless liquid with the possible presence of white to translucent particles (of endogenous nature).

After reconstitution with the solvent provided, dengvaxia must be used immediately.

Any unused dengvaxia or waste material should be disposed of, preferably by heat inactivation or incineration, in accordance with local regulations.

Do not throw away any medicines via wastewater or household waste. Ask a pharmacist on how to throw away medicines that no longer use. These measures will help to protect the environment.

Storage

Store in a refrigerator. Do not freeze. Keep the vaccine in the outer carton in order to protect it from light.

Description

After reconstitution, one dose (0.5 ml) contains 4.5-6.0 log10 ccid50* of each serotype of the cyd dengue virus** (1, 2, 3 and 4).

* ccid50: 50% cell culture infectious dose.

** produced in serum-free vero cells by recombinant dna technology.

The powder is a white, homogenous, freeze-dried powder with possible retraction at the base, and may form a ring-shaped cake.

The solvent (0.4% sodium chloride solution) is a clear, colorless liquid.

After reconstitution with the solvent provided, dengvaxia is a clear, colorless liquid with the possible presence of white to translucent particles.

Excipients/inactive ingredients: essential amino acids including l-phenylalanine, non-essential amino acids, l-arginine hydrochloride, sucrose, d-trehalose dihydrate, d-sorbitol, trometamol, urea, sodium chloride, water for injections.

Mechanism of action

Dengvaxia contains dengue virus serotypes 1, 2, 3 and 4 that have been weakened. Dengvaxia works by stimulating the body's natural defenses (immune system), which produces its own protection (antibodies) against the viruses that cause dengue disease.

Dengue is a viral infection transmitted to humans through the bite of an infected aedes mosquito. Dengue is not transmitted directly from person-to-person. Nevertheless the virus which replicates in an infected individual can be transmitted to other humans through mosquito bites for 4-5 days (maximum 12 days) after the first symptoms appear.

Dengue disease results in a wide range of symptoms including fever, headache, pain behind the eyes, muscle and joint pain, nausea, vomiting, swollen glands or skin rash. Symptoms usually last for 2-7 days. Dengue disease can also be asymptomatic.

However, occasionally dengue can be severe and potentially lead to hospitalization and in rare cases to death. Severe dengue is characterized by high fever and any of the following symptoms: severe abdominal pain, persistent vomiting, rapid breathing, severe bleeding, bleeding in stomach, bleeding gums, fatigue, restlessness, coma, seizure and organ failure.

Source:- http://www.mims.com/philippines/drug/info/dengvaxia

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