其實，不育真的是一件滿殘忍的笑話，在初嘗試“性”這東西時，許多情侶們千方百計地避孕。每當月經來時，都慶幸自己沒懷孕。然而，在真正準備要小孩時，才發現這是多么難的一件事。每當月經來時，都問自己為什么還不能懷孕呢？真的那么難嗎？害怕自己不育。統計數字裡說的每7對夫婦就有一對不育，不育症也變成一件殘忍的事實。
不育會對性愛造成威脅嗎？答案：因人而異。但是，當性愛演變成一種責任，不育療程的束搏，甚至被逼的時候，那原本夫婦倆通過性愛的親密體驗，就變成例行公事，性愛的歡愉將大打折扣！雖然，不育會對夫婦倆帶來疑惑、矛盾、無助與壓力。然而，它卻讓夫婦倆更清楚知道不育對性愛與夫婦倆感情的負面影響，以致他們必須進行無數的溝通來正視以及尋找方案。
~~~不育推垮男人尊嚴~~~
不育推垮了做丈夫的尊嚴，做妻子的責任！
“生兒育女，相夫教子”是妻子的責任，是做媽媽的責任。雖然現今社會，我們推崇男女平等，很多女性都是在各領域裡的佼佼者。可是，在傳統華人社會裡，傳宗接代的觀念還是很強。所以，結婚生育是件多么自然的事。丈夫為成功懷孕的妻子感到慶幸，妻子為成功令她懷孕的丈夫感到光榮與驕傲，這一切是多么自然以及讓人期待的事啊！妻子懷孕，就是提高做男人，做丈夫的尊嚴！
“如果不能夠讓妻子懷孕的話，我還算是男人嗎？”這句話包含著滿滿男人尊嚴受損憤怒和無助的聲音。“就是因為我，害你還未能當爸爸，不如你和我離婚，再娶吧！”這句話聽起來是酸溜溜地，可是它卻是反映出妻子對不育的無奈與悲痛。不能夠令妻子懷孕的丈夫不是男人嗎？不能夠懷孕的妻子就不是女人嗎？當然不是。所以，首先不育夫婦就得接受這觀點。
不育療程決定了我們性愛的方程式！
當性愛是由第三者（醫生）來決定的話，性愛也起了無形的束搏，巨大的壓力，夫婦倆須在固定時間行房的話，那么，性愛因而只是一件僅僅為了生小孩而做的活動，還是還有其他的用意嗎？究竟性愛是什么呢? 夫婦倆對此的觀點又如何呢？不管夫婦對性愛的看法是怎樣，當行房是在有預謀，有計劃下進行的話，它也將演變成一個固定的方程式以及缺乏應有的甜蜜滋味，有些夫婦甚至對“性”產生厭倦！因此，夫婦應該誠實的面對這性愛的改變，以及誠實地說出自己對“性”的要求和看法，以達到共識。
~~~不育帶來負面想法~~~
不育最大的挑戰是“等”。所有的不育療程都是“等”的游戲。就是一個“等”字，累垮了許多不育夫妻，有些覺得當“性”已經不能夠制造下一代時，為何還要去做呢？當這一切的悲觀思想佔據了原本對“性”的渴望，甚至會覺得“性”是多余的……不育仿佛把房事公諸于世……
“性”應該是一件很私人的事。然而，不育夫婦無奈地接受親戚朋友的勸告，醫生的意見，仿佛牽涉了很多人在自己的房事裡。有時候，夫婦難免會有無形的壓力，因為親戚朋友會追問療程進展，造人的進度等問題。所以，一旦決定要接受親戚朋友的幫忙時，就必須有承擔后果的勇氣！至于，有沒有必要把讓親戚朋友牽涉其中？這必須通過夫妻倆的溝通才能做出決定。因為如果不把這牽涉其他人的話，那么，丈夫、妻子就必須把另一方當成不育療程時唯一的精神支柱！這樣，房事自然相對地變輕鬆了，性愛，才會是一種享受。
Wednesday, November 5, 2008
Tuesday, September 9, 2008
哺乳守護寶貝守護你
標榜媲美母乳的配方奶粉，幾十年來成為嬰兒營養的黃金標準，事實上，母乳，才是最天然、最健康的嬰兒食品。雖然各大醫院紛紛推行哺乳政策，然而，放眼望去，媽媽們對哺乳仍有許多迷思，“奶水足夠嗎？”“寶寶夠飽嗎？”“哺乳很麻煩”……
《養生》特邀兩位資深母乳哺育指導專員李雅齊和杜巴（Toobaloshany A/P Vasathakumar）分享哺乳知識，讓寶寶贏在人生起跑點，從哺乳開始。
擔任母乳哺育知識專員多年的李雅齊，說起哺乳好處侃侃而談：“哺乳無論是對母親或嬰兒都有很多好處，事實上，除了各種健康好處，每月還可以節省一大筆購買配方奶粉的金錢，不但符合經濟效益，而且，是寶寶最佳的食物來源，每個疼愛孩子，希望孩子健康成長的母親，都應該選擇哺餵母乳。”
“尤其是初乳，更是母親給寶寶最珍貴的禮物，初乳的脂肪含量較少，蛋白質多，而且含有免疫物質，具有預防嬰兒患病，促使健康發育等重要功能。”李雅齊鼓勵媽媽堅持哺乳，給孩子一個更健康的未來。
全面剖析哺乳誤區
--------------
*胃腸炎（Gastroenteritis）
“哺乳，說難不難，卻也存在許多誤區，幫助新手媽媽揭開迷思，才能輕鬆哺乳，讓母親和寶寶都獲得健康的身心。”杜巴和李雅齊分享一些新手媽媽們常出現的誤區。
*誤區一：擔心寶寶不夠飽或寶寶哭鬧要吮吸，可以偶爾添加配方奶或給奶嘴。
錯！哺乳初期，媽媽會因為種種原因而奶水分泌比較少，愛子心切的家人就會擔心寶寶餓著，急忙加奶粉。這樣一來，導致寶寶的吮吸母奶的次數減少，影響哺乳的成功率。
*誤區二：乳房要經常用沐浴乳清洗，保持乳房干淨。
錯！乳房只需要用干淨水清洗即可，過度清潔反而會造成乳頭過度干燥，破壞乳房天然的防護力。
*誤區三：寶寶經常吮吸乳房是不對的，這樣會造成依賴性。
錯！經常吸吮乳房是正常的，這樣可以滿足及安撫寶寶，並且產生更多的奶水，隨著寶寶逐漸長大，吮吸的間隔時間會逐漸拉長。
*誤區四：每次餵奶，一次只能喂一邊？
錯！一次只喂一邊會減少刺激乳房的次數，乳汁分泌也自然減少，因此，每次哺乳應該換邊喂，盡量兩邊都喂，確保乳汁分泌供應充足，而且避免一邊乳房腫脹的情況出現。
* 誤區五：我想哺乳，但要上班，所以，最好的方法就是放棄哺乳，選用配方奶粉？
錯！職業女性也可以輕鬆哺乳，只要擠出母乳儲存，不但可以確保媽媽乳汁分泌，防止脹奶的痛苦，還可以讓寶寶享用最天然的營養。擠奶可以用擠奶器或手擠，擠出的奶放在母乳儲存袋即可。
* 誤區六：哺乳會使身材走樣。
錯！很多媽媽擔心哺乳會造成身材走樣，其實，哺乳期反而有促進母親恢復身材的作用，提供營養給寶寶，保持母體供需平衡，促進子宮收縮，有利于消耗掉孕期體內蓄積的多余脂肪。
*誤區七：工作忙碌時，不擠乳也沒關係。
專家提醒，千萬不能偷懶不擠乳，因為，沒有“排空”奶水，不只會導致乳腺發炎，也會影響乳汁分泌量。因此，要養成固定擠乳的習慣，有“訂單需求”，大腦才會持續發出製造乳汁的指令，乳汁分泌量才會充足。
哺乳媽媽飲食建議
--------------
哺乳媽媽要讓寶寶健康無病痛，提供高品質乳汁是關鍵，因此，媽媽們也別忘了照顧自己的飲食，母體營養充足，才能確保乳汁分泌營養充足。
多吃：
母乳含有寶寶所需要的各種營養成分，勝于配方奶粉。
糖類：是熱量的主要來源，可由全麥、穀類、蔬果中獲得。
脂肪：宜儘量攝取不飽和脂肪，如葵花油、蔬菜油等。
蛋白質：由魚、肉、蛋、奶、豆等食物中獲得。
維他命和礦物質：脂溶性維他命（A、D、E、K）、水溶性維他命（B、C）和各種礦物質。
水分：哺乳時所需的水分量較大，所以水的補充量要足夠，也可由湯汁或牛奶中獲得。
避免食用：
＊咖啡與濃茶。
＊含脂肪多的食物，如醃肉、鹹蛋、火腿、豆腐等。
＊過鹹或燻肉、鹹魚、火腿、豆腐等。
＊僅提供熱量，但卻無營養價值的食物，如：糖果、巧克力、甜點、可樂、汽水等。
＊刺激性的調味品，如辣椒、胡椒、咖哩等。
＊煙和酒。
哺乳的好處
---------
A) 母親
1.促進母親和寶寶之間的親密感覺。
2.防止產后流血。
3.自然避孕方法。
4.減少患上乳癌、卵巢癌的几率。
5.迅速恢復生產前的體重和身材。
6.幫助產后子宮收縮，排除惡露，使子宮恢復到產前的大小和彈性。
B)寶寶
1.母乳含有寶寶所需要的各種營養成分，而且分量均衡、溫度適中及容易消化。
2.母乳含有抗菌蛋白質和抗體，幫助保護寶寶，提升免疫能力，減少咳嗽、感冒等几率。
3.母乳保護寶寶免受感染，減少支氣管炎、肺炎、腦膜炎、腹瀉等几率，並且預防寶寶發生腹絞痛、哮喘、鼻子敏感和食物敏感。
4.促進寶寶體格、情緒和大腦的理想發育
5.哺喂母乳會讓寶寶感覺安全被愛，甚至，也可以讓寶寶更漂亮，因為，母乳的吮吸方式和奶瓶不同，必須運用上下顎、嘴唇、雙頰肌肉、寶寶顏面神經肌肉運動也不一樣，咀嚼能力更好，而且，臉型也更好看。
註：產后第一個星期或者兩個星期左右的時間，分泌出來的母乳叫做“初乳”。
抓緊原則正確哺乳
--------------
經常穿梭在產房協助新手媽媽進行哺乳工作的杜巴，無論是哺育自己的孩子，或是幫助媽媽們正確哺乳，都有豐富經驗，她表示哺乳可能出現的狀況雖然因人而異，但是只要抓緊正確原則，一般上都不會有太大問題。
正確哺乳的表征
------------
乳頭延伸至寶寶口內。
寶寶張大口、下巴貼著乳房。
寶寶的鼻子沒有接觸乳房。
寶寶的下唇向外彎曲，涵蓋住的乳暈範圍比上唇多。
寶寶稍稍的向上傾斜、下顎碰觸到乳房。
寶寶吮吸、休息后再緩慢及順暢呼吸。
常見問題改善方法
--------------
“部分媽媽在哺乳過程中可能會出現一些常見問題，往往因為缺乏了解或耐性就放棄哺乳，這是非常可惜的。其實，大部分問題都可以解決，只要稍微調整，還是可以繼續哺乳，讓寶寶獲得最好的營養。”杜巴說哺乳的常見問題包括：
乳房腫脹：乳房開始分泌乳汁時，會充盈、變硬、有觸痛感，有時候會感到疼痛，乳頭和乳暈也會變硬，往往在生產后3至5天時發生。
如何改善？
1.用手擠出乳汁或用吸奶器吸出乳汁，使乳房變軟，擠出足夠乳汁，使乳暈變軟，讓寶寶能很容易吸住。
2.餵奶時輕輕按摩乳房。
3.經常給寶寶餵奶。
4.因乳房沉重須戴乳罩，建議使用不帶鋼絲的支援型或舒適型乳罩。
乳頭疼痛：寶寶沒有吸牢乳頭或寶寶的吃奶姿勢不正確時，往往會發生乳頭疼痛。確保寶寶吸奶時上下顎深深包住乳暈，大約包住乳頭根部向外1/2吋的範圍。寶寶放開乳頭后，乳頭應為圓形挺立狀。
如何預防？
1.如餵奶時感到乳頭被掐痛、磨痛或咬痛，檢查寶寶的姿勢是否正確，以及是否吸正乳頭。
2.餵奶后，暫時不要扣上乳罩，讓乳頭自然晾干幾分鐘。
3.增加給寶寶餵奶的次數，縮短每次餵奶的時間，不要讓寶寶太飢餓。
乳管堵塞：乳管堵塞，會在乳房內形成有觸痛或疼痛感的腫塊。如果不加以治療，可導致感染。寶寶的吃奶姿勢或乳房壓力發生變化時，往往會導致乳管堵塞。
如何改善？
1.每次餵奶前，熱敷乳房15～20分鐘。
2.改變餵奶姿勢，讓寶寶的下巴和顎部對準乳管堵塞部位。
3.讓寶寶先吃乳管堵塞一側的乳房。開始的吮吸較有力，有助緩解堵塞。
乳頭內陷：乳頭凹陷于乳暈皮面之下，而不凸出于乳暈平面，輕者僅為乳頭退縮，重者表現為乳頭凹入甚至翻轉。
是否必須放棄哺乳？
如果寶寶能夠很好地含住乳頭，扁平或內陷的乳頭都不應該影響母乳喂養，不過剛開始的階段可能感覺有點痛。產前進行乳房按摩或揉搓乳頭可以改善乳頭內陷，另外，在開始哺乳的頭幾天，喂奶前使用吸奶器可以幫助內陷的乳頭突出。盡量避免脹奶情況。前幾次餵奶，如果有需要，可以請求專業醫護人員幫忙。
《養生》特邀兩位資深母乳哺育指導專員李雅齊和杜巴（Toobaloshany A/P Vasathakumar）分享哺乳知識，讓寶寶贏在人生起跑點，從哺乳開始。
擔任母乳哺育知識專員多年的李雅齊，說起哺乳好處侃侃而談：“哺乳無論是對母親或嬰兒都有很多好處，事實上，除了各種健康好處，每月還可以節省一大筆購買配方奶粉的金錢，不但符合經濟效益，而且，是寶寶最佳的食物來源，每個疼愛孩子，希望孩子健康成長的母親，都應該選擇哺餵母乳。”
“尤其是初乳，更是母親給寶寶最珍貴的禮物，初乳的脂肪含量較少，蛋白質多，而且含有免疫物質，具有預防嬰兒患病，促使健康發育等重要功能。”李雅齊鼓勵媽媽堅持哺乳，給孩子一個更健康的未來。
全面剖析哺乳誤區
--------------
*胃腸炎（Gastroenteritis）
“哺乳，說難不難，卻也存在許多誤區，幫助新手媽媽揭開迷思，才能輕鬆哺乳，讓母親和寶寶都獲得健康的身心。”杜巴和李雅齊分享一些新手媽媽們常出現的誤區。
*誤區一：擔心寶寶不夠飽或寶寶哭鬧要吮吸，可以偶爾添加配方奶或給奶嘴。
錯！哺乳初期，媽媽會因為種種原因而奶水分泌比較少，愛子心切的家人就會擔心寶寶餓著，急忙加奶粉。這樣一來，導致寶寶的吮吸母奶的次數減少，影響哺乳的成功率。
*誤區二：乳房要經常用沐浴乳清洗，保持乳房干淨。
錯！乳房只需要用干淨水清洗即可，過度清潔反而會造成乳頭過度干燥，破壞乳房天然的防護力。
*誤區三：寶寶經常吮吸乳房是不對的，這樣會造成依賴性。
錯！經常吸吮乳房是正常的，這樣可以滿足及安撫寶寶，並且產生更多的奶水，隨著寶寶逐漸長大，吮吸的間隔時間會逐漸拉長。
*誤區四：每次餵奶，一次只能喂一邊？
錯！一次只喂一邊會減少刺激乳房的次數，乳汁分泌也自然減少，因此，每次哺乳應該換邊喂，盡量兩邊都喂，確保乳汁分泌供應充足，而且避免一邊乳房腫脹的情況出現。
* 誤區五：我想哺乳，但要上班，所以，最好的方法就是放棄哺乳，選用配方奶粉？
錯！職業女性也可以輕鬆哺乳，只要擠出母乳儲存，不但可以確保媽媽乳汁分泌，防止脹奶的痛苦，還可以讓寶寶享用最天然的營養。擠奶可以用擠奶器或手擠，擠出的奶放在母乳儲存袋即可。
* 誤區六：哺乳會使身材走樣。
錯！很多媽媽擔心哺乳會造成身材走樣，其實，哺乳期反而有促進母親恢復身材的作用，提供營養給寶寶，保持母體供需平衡，促進子宮收縮，有利于消耗掉孕期體內蓄積的多余脂肪。
*誤區七：工作忙碌時，不擠乳也沒關係。
專家提醒，千萬不能偷懶不擠乳，因為，沒有“排空”奶水，不只會導致乳腺發炎，也會影響乳汁分泌量。因此，要養成固定擠乳的習慣，有“訂單需求”，大腦才會持續發出製造乳汁的指令，乳汁分泌量才會充足。
哺乳媽媽飲食建議
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哺乳媽媽要讓寶寶健康無病痛，提供高品質乳汁是關鍵，因此，媽媽們也別忘了照顧自己的飲食，母體營養充足，才能確保乳汁分泌營養充足。
多吃：
母乳含有寶寶所需要的各種營養成分，勝于配方奶粉。
糖類：是熱量的主要來源，可由全麥、穀類、蔬果中獲得。
脂肪：宜儘量攝取不飽和脂肪，如葵花油、蔬菜油等。
蛋白質：由魚、肉、蛋、奶、豆等食物中獲得。
維他命和礦物質：脂溶性維他命（A、D、E、K）、水溶性維他命（B、C）和各種礦物質。
水分：哺乳時所需的水分量較大，所以水的補充量要足夠，也可由湯汁或牛奶中獲得。
避免食用：
＊咖啡與濃茶。
＊含脂肪多的食物，如醃肉、鹹蛋、火腿、豆腐等。
＊過鹹或燻肉、鹹魚、火腿、豆腐等。
＊僅提供熱量，但卻無營養價值的食物，如：糖果、巧克力、甜點、可樂、汽水等。
＊刺激性的調味品，如辣椒、胡椒、咖哩等。
＊煙和酒。
哺乳的好處
---------
A) 母親
1.促進母親和寶寶之間的親密感覺。
2.防止產后流血。
3.自然避孕方法。
4.減少患上乳癌、卵巢癌的几率。
5.迅速恢復生產前的體重和身材。
6.幫助產后子宮收縮，排除惡露，使子宮恢復到產前的大小和彈性。
B)寶寶
1.母乳含有寶寶所需要的各種營養成分，而且分量均衡、溫度適中及容易消化。
2.母乳含有抗菌蛋白質和抗體，幫助保護寶寶，提升免疫能力，減少咳嗽、感冒等几率。
3.母乳保護寶寶免受感染，減少支氣管炎、肺炎、腦膜炎、腹瀉等几率，並且預防寶寶發生腹絞痛、哮喘、鼻子敏感和食物敏感。
4.促進寶寶體格、情緒和大腦的理想發育
5.哺喂母乳會讓寶寶感覺安全被愛，甚至，也可以讓寶寶更漂亮，因為，母乳的吮吸方式和奶瓶不同，必須運用上下顎、嘴唇、雙頰肌肉、寶寶顏面神經肌肉運動也不一樣，咀嚼能力更好，而且，臉型也更好看。
註：產后第一個星期或者兩個星期左右的時間，分泌出來的母乳叫做“初乳”。
抓緊原則正確哺乳
--------------
經常穿梭在產房協助新手媽媽進行哺乳工作的杜巴，無論是哺育自己的孩子，或是幫助媽媽們正確哺乳，都有豐富經驗，她表示哺乳可能出現的狀況雖然因人而異，但是只要抓緊正確原則，一般上都不會有太大問題。
正確哺乳的表征
------------
乳頭延伸至寶寶口內。
寶寶張大口、下巴貼著乳房。
寶寶的鼻子沒有接觸乳房。
寶寶的下唇向外彎曲，涵蓋住的乳暈範圍比上唇多。
寶寶稍稍的向上傾斜、下顎碰觸到乳房。
寶寶吮吸、休息后再緩慢及順暢呼吸。
常見問題改善方法
--------------
“部分媽媽在哺乳過程中可能會出現一些常見問題，往往因為缺乏了解或耐性就放棄哺乳，這是非常可惜的。其實，大部分問題都可以解決，只要稍微調整，還是可以繼續哺乳，讓寶寶獲得最好的營養。”杜巴說哺乳的常見問題包括：
乳房腫脹：乳房開始分泌乳汁時，會充盈、變硬、有觸痛感，有時候會感到疼痛，乳頭和乳暈也會變硬，往往在生產后3至5天時發生。
如何改善？
1.用手擠出乳汁或用吸奶器吸出乳汁，使乳房變軟，擠出足夠乳汁，使乳暈變軟，讓寶寶能很容易吸住。
2.餵奶時輕輕按摩乳房。
3.經常給寶寶餵奶。
4.因乳房沉重須戴乳罩，建議使用不帶鋼絲的支援型或舒適型乳罩。
乳頭疼痛：寶寶沒有吸牢乳頭或寶寶的吃奶姿勢不正確時，往往會發生乳頭疼痛。確保寶寶吸奶時上下顎深深包住乳暈，大約包住乳頭根部向外1/2吋的範圍。寶寶放開乳頭后，乳頭應為圓形挺立狀。
如何預防？
1.如餵奶時感到乳頭被掐痛、磨痛或咬痛，檢查寶寶的姿勢是否正確，以及是否吸正乳頭。
2.餵奶后，暫時不要扣上乳罩，讓乳頭自然晾干幾分鐘。
3.增加給寶寶餵奶的次數，縮短每次餵奶的時間，不要讓寶寶太飢餓。
乳管堵塞：乳管堵塞，會在乳房內形成有觸痛或疼痛感的腫塊。如果不加以治療，可導致感染。寶寶的吃奶姿勢或乳房壓力發生變化時，往往會導致乳管堵塞。
如何改善？
1.每次餵奶前，熱敷乳房15～20分鐘。
2.改變餵奶姿勢，讓寶寶的下巴和顎部對準乳管堵塞部位。
3.讓寶寶先吃乳管堵塞一側的乳房。開始的吮吸較有力，有助緩解堵塞。
乳頭內陷：乳頭凹陷于乳暈皮面之下，而不凸出于乳暈平面，輕者僅為乳頭退縮，重者表現為乳頭凹入甚至翻轉。
是否必須放棄哺乳？
如果寶寶能夠很好地含住乳頭，扁平或內陷的乳頭都不應該影響母乳喂養，不過剛開始的階段可能感覺有點痛。產前進行乳房按摩或揉搓乳頭可以改善乳頭內陷，另外，在開始哺乳的頭幾天，喂奶前使用吸奶器可以幫助內陷的乳頭突出。盡量避免脹奶情況。前幾次餵奶，如果有需要，可以請求專業醫護人員幫忙。
Men, Breast Cancer, and the BRCA Gene Mutation
We generally think of breast cancer as being only a problem for women; but breast cancer can also occur in men, although far less often than in women. On average, breast cancer occurs in less than 1 in 1,000 American men and accounts for less than 0.5 percent of all cancer deaths in men.
If a man carries a BRCA2 mutation, however, he has a much greater lifetime risk (about 7 percent) of developing breast cancer. He also faces an increased risk of prostate cancer. BRCA1 mutations are less likely than BRCA2 mutations to predispose men to breast cancer.
A man should ask his doctor about a screening test for mutations in his BRCA genes if:
several close female relatives have a history of breast or ovarian cancer
a first-degree relative — mother, sister, brother, or offspring — develops breast cancer before age 50, or has had a positive test for a BRCA gene mutation
The median age of onset of breast cancer in men is about 65, approximately 5 to 10 years later than the age of onset among women. In men with a BRCA mutation, breast cancer occurs at an earlier age and is more aggressive than other types of male breast cancer.
The decision to obtain genetic tests for BRCA mutations must be weighed carefully because the most complete test costs about $3,200, and insurance companies may not pay for any or all of these costs unless your doctor provides convincing reasons for obtaining the test.
Even if a man has already developed breast cancer, he should still get a test for a BRCA mutation, for two reasons: First, finding a BRCA2 mutation increases the likelihood of breast cancer in his apparently normal breast and, second, this information may prove valuable for other members of his family.
There is little information on what steps a man might take to detect breast cancer at an early stage, when it is most treatable. He should, however, be alert to the appearance of a painless, firm mass beneath or around the nipple.
Mammography, which is abnormal in more than 80 percent of men with breast cancer, can distinguish cancer from the more common problem of gynecomastia (breast enlargement in men).
If a man carries a BRCA2 mutation, however, he has a much greater lifetime risk (about 7 percent) of developing breast cancer. He also faces an increased risk of prostate cancer. BRCA1 mutations are less likely than BRCA2 mutations to predispose men to breast cancer.
A man should ask his doctor about a screening test for mutations in his BRCA genes if:
several close female relatives have a history of breast or ovarian cancer
a first-degree relative — mother, sister, brother, or offspring — develops breast cancer before age 50, or has had a positive test for a BRCA gene mutation
The median age of onset of breast cancer in men is about 65, approximately 5 to 10 years later than the age of onset among women. In men with a BRCA mutation, breast cancer occurs at an earlier age and is more aggressive than other types of male breast cancer.
The decision to obtain genetic tests for BRCA mutations must be weighed carefully because the most complete test costs about $3,200, and insurance companies may not pay for any or all of these costs unless your doctor provides convincing reasons for obtaining the test.
Even if a man has already developed breast cancer, he should still get a test for a BRCA mutation, for two reasons: First, finding a BRCA2 mutation increases the likelihood of breast cancer in his apparently normal breast and, second, this information may prove valuable for other members of his family.
There is little information on what steps a man might take to detect breast cancer at an early stage, when it is most treatable. He should, however, be alert to the appearance of a painless, firm mass beneath or around the nipple.
Mammography, which is abnormal in more than 80 percent of men with breast cancer, can distinguish cancer from the more common problem of gynecomastia (breast enlargement in men).
The Morning After Pill - Without a Prescription
Some time ago, I served for several years on a U.S. Food and Drug Administration advisory committee. All of us recognized that our role was purely advisory and that our recommendations might either be accepted or rejected.
We did feel, however, that the final decisions were based solely on scientific and medical factors, as they always should be. There is no legitimate place for political influence in the approval of medications.
That's not the case with the FDA's recent approval of over-the-counter purchase of the contraceptive drug popularly known as "Plan B" or "morning after pill." The long-awaited approval hinged on a political compromise that limits nonprescription purchase of the drug to women aged 18 or older.
Andrew von Eschenbach, acting head of the FDA, claimed there was uncertainty about the drug's safety in younger women in an apparent effort to downplay the political motivation for the age limit. Yet staff scientists at the FDA concluded two years ago that nonprescription sales of the drug would be safe for women of all reproductive ages.
Back in 1994, the FDA approved sales of Plan B pills by prescription only with no age restriction, and today teenagers younger than 18 can still obtain Plan B with a prescription. Several years ago an FDA advisory committee recommended over-the-counter sales of Plan B by an overwhelming 23-4 vote.
But political appointees at the FDA did not implement the committee's recommendation, presumably bowing to pressure from high-ranking members of the administration - probably the president himself. Apparently, the conservative right worries that availability of a morning after pill would increase teenage promiscuity.
I suppose it's all right for a 17-year-old girl and her family to face the many problems of an unwanted pregnancy because she couldn't get Plan B pills. After all, her sacrifice is protecting other teenagers, who might be more tempted to practice unprotected sex if they knew they could get Plan B pills without a prescription. Give me a break!
There is no evidence of dramatic increases in teen sex in the nine states that have allowed nonprescription sales of Plan B to women of all ages. For now, over-the-counter sales of Plan B must remain a limited victory, because it will do nothing to reduce the high rate of teenage pregnancy in this country. (And, as with all other non-barrier methods of birth control, Plan B will not protect against sexually transmitted infections.)
Groups in favor of allowing nonprescription sales of Plan B to women of all ages will continue their fight. Meanwhile, the long political impasse on the confirmation of the FDA's chief will undoubtedly end with congressional confirmation of Dr. von Eschenbach.
The "morning after pill" is not a very accurate name for this drug. Plan B requires taking two pills, each containing a large dose of levonorgestrel, a component of many birth control pills already on the market. It should more appropriately be called the "72 hours after" pill, because the first of the two pills must be taken within 72 hours after unprotected sex. The second pill is taken 12 hours after the first.
Plan B is said to be 90 percent effective in preventing pregnancy, though its effectiveness is a function of how soon after intercourse the first pill is taken. How many teenagers too young to buy Plan B over the counter will be sophisticated enough to get and fill a Plan B prescription after unprotected sex on a Saturday night? Even if she were eligible for nonprescription Plan B, could the teenager afford $25 to $50, the projected cost of the two Plan B pills? Unlike prescription Plan B, the cost of nonprescription Plan B is unlikely to be covered by health insurance.
Nonprescription Plan B is expected to be available in pharmacies in early 2007. A photo ID will be required to enforce the age requirement. At least these women will not have to take off their shoes as they do at airports.
We did feel, however, that the final decisions were based solely on scientific and medical factors, as they always should be. There is no legitimate place for political influence in the approval of medications.
That's not the case with the FDA's recent approval of over-the-counter purchase of the contraceptive drug popularly known as "Plan B" or "morning after pill." The long-awaited approval hinged on a political compromise that limits nonprescription purchase of the drug to women aged 18 or older.
Andrew von Eschenbach, acting head of the FDA, claimed there was uncertainty about the drug's safety in younger women in an apparent effort to downplay the political motivation for the age limit. Yet staff scientists at the FDA concluded two years ago that nonprescription sales of the drug would be safe for women of all reproductive ages.
Back in 1994, the FDA approved sales of Plan B pills by prescription only with no age restriction, and today teenagers younger than 18 can still obtain Plan B with a prescription. Several years ago an FDA advisory committee recommended over-the-counter sales of Plan B by an overwhelming 23-4 vote.
But political appointees at the FDA did not implement the committee's recommendation, presumably bowing to pressure from high-ranking members of the administration - probably the president himself. Apparently, the conservative right worries that availability of a morning after pill would increase teenage promiscuity.
I suppose it's all right for a 17-year-old girl and her family to face the many problems of an unwanted pregnancy because she couldn't get Plan B pills. After all, her sacrifice is protecting other teenagers, who might be more tempted to practice unprotected sex if they knew they could get Plan B pills without a prescription. Give me a break!
There is no evidence of dramatic increases in teen sex in the nine states that have allowed nonprescription sales of Plan B to women of all ages. For now, over-the-counter sales of Plan B must remain a limited victory, because it will do nothing to reduce the high rate of teenage pregnancy in this country. (And, as with all other non-barrier methods of birth control, Plan B will not protect against sexually transmitted infections.)
Groups in favor of allowing nonprescription sales of Plan B to women of all ages will continue their fight. Meanwhile, the long political impasse on the confirmation of the FDA's chief will undoubtedly end with congressional confirmation of Dr. von Eschenbach.
The "morning after pill" is not a very accurate name for this drug. Plan B requires taking two pills, each containing a large dose of levonorgestrel, a component of many birth control pills already on the market. It should more appropriately be called the "72 hours after" pill, because the first of the two pills must be taken within 72 hours after unprotected sex. The second pill is taken 12 hours after the first.
Plan B is said to be 90 percent effective in preventing pregnancy, though its effectiveness is a function of how soon after intercourse the first pill is taken. How many teenagers too young to buy Plan B over the counter will be sophisticated enough to get and fill a Plan B prescription after unprotected sex on a Saturday night? Even if she were eligible for nonprescription Plan B, could the teenager afford $25 to $50, the projected cost of the two Plan B pills? Unlike prescription Plan B, the cost of nonprescription Plan B is unlikely to be covered by health insurance.
Nonprescription Plan B is expected to be available in pharmacies in early 2007. A photo ID will be required to enforce the age requirement. At least these women will not have to take off their shoes as they do at airports.
Breakthrough: Circumcision Lowers Risk of HIV Infection
Huge news in the fight against the spread of AIDS: Two studies in African countries have yielded conclusive evidence that circumcision more than halves the chances that a man will acquire an HIV infection.
AIDS experts call the findings extraordinary — as important as the initial identification of the virus and the development of life-saving treatment with drug combinations.
They predict that widespread circumcision in Africa could prevent 2 million infections and 300,000 deaths over the next 10 years. Implementation of mass circumcision, however, faces ethical and religious barriers, and too few health care workers are available to perform these numbers of safe circumcisions.
The studies, published in February in The Lancet, confirmed the results of an earlier report from South Africa which showed that circumcision reduced the risk of AIDS by 60 percent. Both studies were supported by the National Institutes of Health and were stopped early because of the strong evidence that circumcision protects against HIV.
Scientists believe that circumcision is effective because it removes tissue which contains cells that are most sensitive to infection by the HIV virus.
Circumcision presumably protects men in the U.S., as well. However, it remains critical for circumcised men to continue using condoms since circumcision does not eliminate all risk. And it is not clear whether circumcision reduces the risk that an HIV-infected man will transmit the infection to his sexual partners.
AIDS experts call the findings extraordinary — as important as the initial identification of the virus and the development of life-saving treatment with drug combinations.
They predict that widespread circumcision in Africa could prevent 2 million infections and 300,000 deaths over the next 10 years. Implementation of mass circumcision, however, faces ethical and religious barriers, and too few health care workers are available to perform these numbers of safe circumcisions.
The studies, published in February in The Lancet, confirmed the results of an earlier report from South Africa which showed that circumcision reduced the risk of AIDS by 60 percent. Both studies were supported by the National Institutes of Health and were stopped early because of the strong evidence that circumcision protects against HIV.
Scientists believe that circumcision is effective because it removes tissue which contains cells that are most sensitive to infection by the HIV virus.
Circumcision presumably protects men in the U.S., as well. However, it remains critical for circumcised men to continue using condoms since circumcision does not eliminate all risk. And it is not clear whether circumcision reduces the risk that an HIV-infected man will transmit the infection to his sexual partners.
Should All Girls Get Cervical Cancer Vaccine?
Last spring the FDA approved a long-awaited vaccine to protect against cervical cancer. Now people are wondering who should be vaccinated and when.
Cancer of the cervix (the outer end of the uterus) causes nearly 4,000 deaths a year among women in the U.S. Most cervical cancers are caused by infections with certain strains of the human papillomavirus (HPV), which also can produce warts. In trials, the vaccine Gardasil has completely prevented infections caused by about half of these cancer-causing strains of HPV. The vaccine is given in a series of three shots over a six-month period.
The ideal time for vaccinating girls is before they become sexually active. Some public health officials have advocated mandatory vaccination for all girls before they reach puberty, just as certain other vaccines are required before children can enter public schools.
But conservative groups have argued that immunizing preteens would encourage sexual activity. They oppose a requirement for immunization. Some of them may even prefer a delay in voluntary administration of the vaccine.
I can't believe that a young girl would be encouraged to engage in sex by thinking, "Well, it's all right to go ahead and have sex. I got the vaccine so I'm not going to get cervical cancer 20 to 40 years from now." The reality is that young girls may choose to have sex no matter what we adults think. Why not protect them now from a disease that could kill them?
Though I have mixed feelings about mandatory vaccination with Gardasil, I would surely advise it for every girl before puberty. Once an infection occurs, it is too late to provide this protection against cervical cancer.
Cancer of the cervix (the outer end of the uterus) causes nearly 4,000 deaths a year among women in the U.S. Most cervical cancers are caused by infections with certain strains of the human papillomavirus (HPV), which also can produce warts. In trials, the vaccine Gardasil has completely prevented infections caused by about half of these cancer-causing strains of HPV. The vaccine is given in a series of three shots over a six-month period.
The ideal time for vaccinating girls is before they become sexually active. Some public health officials have advocated mandatory vaccination for all girls before they reach puberty, just as certain other vaccines are required before children can enter public schools.
But conservative groups have argued that immunizing preteens would encourage sexual activity. They oppose a requirement for immunization. Some of them may even prefer a delay in voluntary administration of the vaccine.
I can't believe that a young girl would be encouraged to engage in sex by thinking, "Well, it's all right to go ahead and have sex. I got the vaccine so I'm not going to get cervical cancer 20 to 40 years from now." The reality is that young girls may choose to have sex no matter what we adults think. Why not protect them now from a disease that could kill them?
Though I have mixed feelings about mandatory vaccination with Gardasil, I would surely advise it for every girl before puberty. Once an infection occurs, it is too late to provide this protection against cervical cancer.
Faith-based Medicine
For decades Catholic hospitals have followed the practice of declining to perform abortions or to deliver other services they interpret as interrupting life after conception.
But lately I've been hearing about a new type of faith-based medical practice in private medical clinics: doctors, mostly obstetrician-gynecologists or family practitioners, who tailor their medical care to their faith and ethical beliefs. Many so-called "faith-based" practices are opening in rural areas where people have limited access to more conventional medicine.
These doctors offer "natural family planning," a process of counseling and education that enables a woman, by monitoring her body temperature, to time her intercourse so that pregnancy will be more or less likely. The same doctors shun modern measures like intra-uterine devices, the morning-after pill, abortions, sterilizations, and in vitro fertilizations.
But it is simply not true, as these doctors claim, that natural family planning is as effective as birth control pills or other contraceptive measures. I and many other doctors also object to their implication that using pills and devices to avoid unwanted pregnancy is equivalent to abortion.
I have no problem with faith-based practices that allow doctors and patients to avoid discussions of issues they both find objectionable. But it is not good enough for these doctors and clinics merely to state that they provide natural family planning. Rather, I believe that patients must be fully informed that the medical care offered in these private clinics does not include all medical options that their patients can legally consider.
I really believe, however, it is best for all patients to be made aware of every measure for protecting and promoting their health, not only for birth control but also for other aspects of their well-being and medical care.
I read in one article that in some clinics doctors routinely pray for their patients as a form of therapy. I can only say that, the moment a doctor starts to pray for me as a form of treatment, "I'm outta here!" I look to my doctors for good medical care, not divine intervention.
Here's an example of a different and unacceptable "faith-based" practice: pharmacists who refuse to fill prescriptions for oral contraceptives and possibly other medications which, for religious reasons, they do not feel should be used by any patient. If any pharmacists continue to behave in this manner, I believe their licenses should be revoked.
The job of a pharmacist is to dispense medicines ordered by a patient's doctor, not to decide unilaterally which ones they believe are suitable. It sounds too much like President Bush, who signs bills passed by Congress, but then indicates which portions of the bills he will not follow or enforce.
But lately I've been hearing about a new type of faith-based medical practice in private medical clinics: doctors, mostly obstetrician-gynecologists or family practitioners, who tailor their medical care to their faith and ethical beliefs. Many so-called "faith-based" practices are opening in rural areas where people have limited access to more conventional medicine.
These doctors offer "natural family planning," a process of counseling and education that enables a woman, by monitoring her body temperature, to time her intercourse so that pregnancy will be more or less likely. The same doctors shun modern measures like intra-uterine devices, the morning-after pill, abortions, sterilizations, and in vitro fertilizations.
But it is simply not true, as these doctors claim, that natural family planning is as effective as birth control pills or other contraceptive measures. I and many other doctors also object to their implication that using pills and devices to avoid unwanted pregnancy is equivalent to abortion.
I have no problem with faith-based practices that allow doctors and patients to avoid discussions of issues they both find objectionable. But it is not good enough for these doctors and clinics merely to state that they provide natural family planning. Rather, I believe that patients must be fully informed that the medical care offered in these private clinics does not include all medical options that their patients can legally consider.
I really believe, however, it is best for all patients to be made aware of every measure for protecting and promoting their health, not only for birth control but also for other aspects of their well-being and medical care.
I read in one article that in some clinics doctors routinely pray for their patients as a form of therapy. I can only say that, the moment a doctor starts to pray for me as a form of treatment, "I'm outta here!" I look to my doctors for good medical care, not divine intervention.
Here's an example of a different and unacceptable "faith-based" practice: pharmacists who refuse to fill prescriptions for oral contraceptives and possibly other medications which, for religious reasons, they do not feel should be used by any patient. If any pharmacists continue to behave in this manner, I believe their licenses should be revoked.
The job of a pharmacist is to dispense medicines ordered by a patient's doctor, not to decide unilaterally which ones they believe are suitable. It sounds too much like President Bush, who signs bills passed by Congress, but then indicates which portions of the bills he will not follow or enforce.
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