Top videos
ormal sperm densities range from 15 million to greater than 200 million sperm per milliliter of semen. You are considered to have a low sperm count if you have fewer than 15 million sperm per milliliter or less than 39 million sperm total per ejaculate.
Given the success of drugs to treat erectile dysfunction, such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra), drug companies have sought a comparable drug for women. Viagra has even been tried as a treatment for sexual dysfunction in women. However, the Food and Drug Administration (FDA) hasn't approved this use of Viagra. Indeed, until recently there were no FDA-approved drugs for treating sexual arousal or sexual desire problems in women. Yet 4 in 10 women report having sexual concerns. A prescription medication known as flibanserin (Addyi) — originally developed as an antidepressant — has been approved by the FDA as a treatment for low sexual desire in premenopausal women. A daily pill, Addyi may boost sex drive in women with low sexual desire and who find the experience distressing. Potentially serious side effects include low blood pressure, dizziness and fainting, particularly if the drug is mixed with alcohol. Experts recommend that you stop taking the drug if you don't notice an improvement in your sex drive after eight weeks.
The obstetric examination is distinct from other examinations in that you, the clinician, are trying to assess the health of two individuals – the mother and the fetus – simultaneously. From the initial history, you should be able to judge the health of the pregnancy, any risk factors that need to be addressed, and any concerns from the parents. The history is an opportunity for you to find out how much the parents know about pregnancy, labour and delivery and if they have any preferences to which these events are carried out. A carefully taken history will also direct your attention to specific signs during the examination. As such, it is important that you develop a concise and systematic method of taking the history and carrying out the examination so that you do not miss any important information. This article focuses primarily on the examination. Pregnancy is a sensitive issue, especially for the primigravida’s. Therefore, extra care is needed when you approach a pregnant woman. Always obtain expressed informed consent before examining her and have a chaperone accompany you throughout the examination. A walk-through of what you will be doing is a good way of reassuring the patient and allows the examination to go on smoothly. It is also important to let your patient know that if the examination is too painful, she can stop at any time she wants. Finally, before you begin, you should always wash your hands, especially at an OSCE station.
Septoplasty (SEP-toe-plas-tee) is a surgical procedure to correct a deviated septum — a displacement of the bone and cartilage that divides your two nostrils. During septoplasty, your nasal septum is straightened and repositioned in the middle of your nose.
Results Sinusitis was characterized as acute in 26 patients, subacute in 5 (including 1 pyocele), and chronic in 8 (including 2 fungal infections). No tumors were found. Isolated sinus cysts were excluded from the study. Headache, the main symptom in 32 patients (82%), was localized most commonly on the vertex. Other common complaints were rhinitis, dizziness, eye symptoms, and fever. In 2 patients, the finding was occult. Eight patients (21%) presented with cranial nerve deficits, and 1 patient had an intracranial complication. Sinus irrigation was performed in 16 patients (41%) and sphenoidotomy was performed in 10 (26%). Fifteen patients (38%) were treated with antibiotic drugs alone. Within 3 months, 31 (84%) of 37 patients had recovered from the illness; 5 still experienced headaches despite having normalized radiographic findings; and 1 had permanent unilateral visual loss. Two patients were lost to follow-up.
General Considerations Because a discussion of reproductive issues may be difficult for some women, it is important to obtain the history in a relaxed and private setting. The patient should be clothed, particularly if she is meeting the provider for the first time. Ordinarily, the patient should be interviewed alone. Exceptions may be made for children, adolescents, and mentally impaired women, or if the patient specifically requests the presence of a caretaker, friend, or family member. However, even in these circumstances, it is desirable for the patient to have some time to speak with the clinician privately. The manner of address should be formal using the title Mrs., Ms., Miss, or Dr. with the patient’s surname, unless the patient requests otherwise. In some settings, it may be appropriate for nursing staff to be involved with history taking. A nurse may be perceived as less threatening, and may be able to take the history in a less hurried manner.1 The provider can verify the history and focus on areas of concern. Alternatively, it may be helpful to ask the patient to complete a self-history form on paper or by computer prior to speaking with the provider. This allows the provider to devote time to addressing positive responses, and ensures that important questions are not missed. Hasley2 showed that responses to a computer-based questionnaire designed to update a patient’s gynecologic history were equivalent to those obtained during a personal interview. Several studies involving patients in non-gynecologic settings have shown that patients are more likely to provide sensitive information when responding to a computer-based questionnaire as opposed to a personal interview or even a paper questionnaire.3 In order to increase a patient’s level of comfort during the interview, questions should be asked in an open-ended and nonjudgmental way. Assumptions should not be made about aspects of the patient’s background such as sexual orientation. At the conclusion of the interview, patients should be asked whether there are concerns that they would like to discuss that were not addressed previously in the interview.