How to manage my health,....life style management? what is it doc?

General lifestyle management
Written by Dr Dan Rutherford, GP

There are a number of lifestyle factors that are known to impact your overall health and wellbeing.

Alcohol

Alcohol is high in calorie content and low on nutrition. It contributes to weight gain and if you drink too much, too often, it can lead to all sorts of health problems such as high blood pressure and liver damage.

We may all overindulge from time to time, but try not to make this a regular thing. Drinking a lot in one session is never a good thing for your health.

There has been a lot of emphasis on young binge drinkers, but if you are female and have one glass of red wine at home each night, you will exceed the government guidelines for safe drinking.

Exercise

Most people think of exercise solely in terms of weight loss, but it also builds muscles and bones, lifts mood and is a great way of beating stress. If you don't do 30 minutes of walking most days, plus one or two aerobic sessions a week, you aren't exercising enough.

If you want to make changes to your routine, bear in mind it takes three weeks to adopt a new habit, so you should draw up a plan that carries you beyond this point.

Sleep

Most adults need six to eight hours of sleep each night. When we sleep, we rest and our body is able to renew its energy. This may be why a good night's sleep seems to improve the immune system, minimising our risk of illness.

Sleep is also important because of dreams. When we dream, we process all the events of daily life. Getting a good night's sleep, therefore, influences our psychological wellbeing.

Smoking

Smoking causes cell damage, which can lead to illnesses such as cancer and heart disease. It also drains the body of many essential vitamins and minerals, affecting your ability to absorb these vital nutrients. The only way to avoid this damage is to stop smoking.

Stress

We all have an instinctive stress response that releases hormones into our bloodstream when we are faced with danger.

These hormones cause instant mental and physical change in us, giving added strength and endurance so we can fight or take flight.

Instead of using our stress hormones in emergencies, we live at such a pace that many of us activate them all the time - like when we are going to miss a train or someone cuts us up on the motorway.

Most tense people don't give themselves sufficient time and space to rest after each stress-filled moment. With no release, your stress hormones keep on working, which is why there are so many people around who lose their tempers at the slightest provocation.

If this sounds like you, make learning how to reduce and cope with stress a priority.

What we drink

Good hydration is essential for mind and body, so make sure you drink plenty of water every day. Not all drinks are equal, so if you need to boost your liquid intake, watch your caffeine (and sugar) levels don't creep up.

Where we get energy from

The food we eat is used to provide energy for every function in the body, from walking and talking to digesting and breathing.

The main types of food - carbohydrate, protein and fats - are important sources of energy.

Current guidelines suggest that we should get:

o about 50 per cent of our energy from carbohydrates (cereals, bread, pasta and potatoes)

o 10-15 per cent from protein (meat, cheese, soya)

o less than 30 per cent of energy from fats (70g per day for women, 100g for men). Many of us eat more than this a day.


The actual amount of energy you require will depend upon the type of lifestyle you lead.

The recommended figures are 2000 calories per day for women and 2500 for men – but you may need less than this if you take little exercise and sit at a desk all day, and more than this if your job involves manual labour.

For further advice on improving your lifestyle, see the factsheets below.

why i get headache easy angry, everytime i have menstruation.. doc?

Premenstrual syndrome (PMS or PMT)
Written by Dr Philip Owen, consultant obstetrician and gynaecologist

What is premenstrual syndrome?


PMS or PMT?
The terms premenstrual syndrome (PMS) and premenstrual tension (PMT) are interchangeable.
Around 90 per cent of menstruating women get advance warning of an approaching period because of physical and/or psychological changes in the days before their period begins.

For most women the symptoms are mild, but a small proportion finds their symptoms so severe they dread this time of the month.

The terms ‘mild’ and ‘severe’ in respect of PMS are arbitrary, but relate to the extent of disruption to your home and work life that's attributable to the monthly cycle.

About a third of women say PMS significantly affects their life, with 5 to 10 per cent classifying their PMS as severe.

Symptoms of PMS


© NetDoctor/Justesen
For some women, the days before the start of their period can be awful.
There are more than 100 recognised symptoms that may be due to PMS. Fortunately, most women experience only a handful of problems. The most common symptoms are listed below.

Psychological

o Irritability.

o Mood swings.

o Losing your temper easily.

o Loss of confidence.

o Crying for no particular reason.

o Aggression.

o Poor concentration.

o Tiredness.


Physical

o Breast tenderness.

o Abdominal swelling or bloating.

o Weight gain.

o Swollen ankles.

o Headaches and possibly migraine.


None of these symptoms is exclusive to PMS. They can be caused by other conditions such as depression, stress, thyroid gland problems (under- or over-activity) and anaemia.

How do I know if I have PMS?


PMDD
Premenstrual dysphoric disorder (PMDD) is a mood disorder that occurs during the menstrual cycle.
The symptoms are similar to PMS, but are severe enough to impair or prevent quality of life.
PMDD is a depressive disorder.
While blood tests and urine tests are helpful in making sure there isn't another cause for PMS symptoms, there is no test that can diagnose PMS.

Instead, diagnosis is based upon the type of symptoms and when they occur. The symptoms of PMS have a fairly consistent relationship with the start and finish of a period, which is an essential clue to the diagnosis.

However, it is possible to have more than one problem at the same time, so care needs to be taken by doctors not to ‘blame the hormones’ too quickly.

Most women with PMS notice a gradual worsening of their symptoms during the week running up to their period, with a rapid or gradual disappearance of symptoms when their period starts.

But sometimes symptoms can persist during your period or even for a couple of days after it has finished.

To help doctors diagnose PMS, it helps to keep a diary of your symptoms and their severity over a few consecutive months.

A cyclical pattern should be apparent, and a diagnosis of PMS is usually only made if there are 10 consecutive symptom-free days each month.

What causes PMS?


Hormone levels
Measuring hormone levels is of no help in understanding PMS because there are no differences between women who get PMS and those who don't.
It is not exactly known what causes PMS. Common sense indicates it must somehow be linked to the fluctuating levels of female hormones experienced after ovulation. But the subtleties of why some women are more affected than others are not understood.

Normal fluctuations in hormone levels are responsible for some of the symptoms most commonly associated with the monthly cycle, such as bloating, breast tenderness or headaches.

Women who suffer from PMS may possibly have a lower than normal level of a certain chemical in their brain (serotonin), which may explain some of the non-physical symptoms such as irritability, depression and mood swings.

PMS is not caused by any underlying abnormality with the pelvic organs.

When should I seek treatment?

Recognising your symptoms are due to PMS is an important first step.

For the majority of women, the symptoms are a minor inconvenience you can recognise, anticipate and deal with yourself.


Who do I talk to?
A visit to your GP is usually the first step if you are suffering with PMS.
You could ask for a double appointment to give more time for discussion.
Or your GP may prefer to have a quick word at first, then ask you to come back and discuss things in depth.
The Family Planning Clinic and Well-Woman Clinic are other sources of help.
You may seek reassurance from your doctor, but do not necessarily need or want treatment. The value of such a discussion can be high and result in significant improvement in your symptoms.

For a minority of women, PMS is serious enough to affect work, daily life and relationships. If this sounds like you, you should see your GP to discuss your problems, possibly with a view to some treatment.

Women with severe symptoms who have not responded to simple treatments might wish to see a specialist. This usually means a gynaecologist, but a psychiatrist with a particular interest in treating severe PMS can sometimes be more appropriate.

What treatments are available?


The placebo effect
Part of the reason few PMS treatments provide long-term relief is the so-called 'placebo effect'.
A placebo is a treatment that is ineffective (eg a dummy tablet) but has the psychological effect of making you feel better.
To demonstrate a treatment is better than a placebo requires careful scientific study.
Not all PMS treatments have been subjected to evaluation in this way.
There are many treatments for PMS, most of which have some short-term benefit. However, few provide relief for longer than a few months.

Treatment will depend upon the nature of the symptoms and their severity.

For many women, simple changes to diet and lifestyle, reducing alcohol and caffeine intake and cutting down on cigarettes will make the monthly symptoms more bearable. Your GP can give you guidance in this.

A suitable diet sheet is available via the National Association for Premenstrual Syndrome (NAPS) at www.pms.org.uk.

Non-hormonal treatments

Vitamin B6

This is also known as pyridoxine. It is commonly recommended for mood swings and irritability.

There is some scientific support for its use for mild symptoms, but you need to be careful not to take too high a dose. It is advisable to consult your doctor before starting treatment.

Evening primrose oil (EPO)

Capsules of EPO can be helpful in alleviating premenstrual breast pain in some women. However, the evidence in favour of its effect is slight and it has been withdrawn from NHS prescription for this reason.

Bromocriptine and cabergoline

Bromocriptine (eg Parlodel) and cabergoline (Dostinex) reduce the output from the brain of a hormone called prolactin. Prolactin is the hormone that stimulates the breasts to produce milk.

These drugs may be useful if premenstrual breast pain is a major symptom, but their long-term use should be avoided.

Diuretics (water tablets)

Diuretics (water tablets) may give relief from ankle swelling. They will not relieve abdominal bloating, which is not caused by fluid retention but by relaxation and distension of the muscle in the wall of the bowel.

Diuretics need to be prescribed by a doctor and should only be taken for a few days each month in the lowest of doses.

Antidepressants

There is much enthusiasm for the use of a class of antidepressants called SSRIs (eg Prozac) in the treatment of severe PMS where the symptoms are mostly depression, mood swings, irritability, etc.

The results of treatment are often dramatic and are supported by scientific studies. Side effects can sometimes be a problem. Discussion with a GP or specialist is essential before starting treatment.

Hormonal preparations

Progestogens

A group of hormones taken for 10 to 14 days before the beginning of the period. Progestogens are widely prescribed and have relatively few side effects.

It was once thought that PMS was due to a lack of progestogen in the bloodstream, but it is now recognised this isn't the case.

Some women do gain short-term relief of mild symptoms with progestogens. Most scientific studies do not support their use.

Combined oral contraceptive (COC) pill

There is no good evidence that the Pill works in PMS, but it is often prescribed, especially if contraception is required. Some women find the COC gives them PMS because of the hormones contained in the pill.

There is some initial evidence to suggest the combined Pill called Yasmin, which contains a novel progestogen, may be of some benefit to women with PMS. However, more data is needed.

Danazol

Danazol (eg Danol) is a synthetic hormone based on the male hormone testosterone. Its use in PMS is supported by scientific studies.

It has a number of side effects, such as encouraging the growth of body hair and other masculinising effects, which means it is only suitable for use in low doses and will not be tolerated by all women.

Pregnancy must be avoided while taking this medication.

Oestrogen patches and implants

Extra oestrogen (one of the female hormones) via patches or implants can suppress ovulation and reduce the naturally occurring hormone fluctuations.

There is some evidence to support its use in PMS. Usually patches and implants will only be used on the advice of a gynaecologist.

Mirena intra-uterine system (IUS)

Mirena is in fact a contraceptive device, which is placed inside the uterus (womb). It releases a small dose of progestogen hormone into the body.

Most women experience a reduction in the heaviness and duration of their periods and some say it improves their PMS. It may be combined with an oestrogen patch or implant.

Treatments for severe PMS

Medicines

Drugs known as LHRH analogues or GnRH analogues (such as Zoladex, Prostap and Synarel) are potent medicines used by gynaecologists for a number of conditions.

They temporarily ‘switch off’ a woman's ovaries, which usually gives relief from PMS within two months. They are only suitable for short-term use up to six months.

LHRH analogues may be used to confirm the diagnosis of PMS and to help guide you and your gynaecologist towards considering surgery. They are used only in severe and difficult-to-treat PMS.

One of the potential disadvantages of using these particular drugs is they cause flushings and sweats due to the drop in oestrogen output from the ovaries (like that which occurs in the menopause).

They also accelerate the natural rate of bone loss and can therefore increase your chances of developing osteoporosis (fragile bones).

To counter this, they are usually combined with a drug called tibolone (Livial) that mimics HRT. Doctors call this ‘add-back’ treatment.

Surgery


Hysterectomy & PMS
Removing the womb only (hysterectomy) may not improve PMS.
This is because you can still get PMS if one or both ovaries are still present and functional.
For a small minority of women, surgical removal of the ovaries is the only measure that will allow them to continue a normal existence, free of PMS.

This is a major and still controversial step to be considered carefully by you, your GP and gynaecologist.

Once the ovaries are removed, you must be prepared to take hormone replacement therapy (HRT) until at least the age of 50.

Because it is such a drastic step, the use of LHRH analogues are usually used first - effectively non-surgical ways of putting the ovaries out of action. If this treatment works well, there is more chance surgery will be effective.

Many gynaecologists will not operate for PMS alone, but will do so if there are additional problems, such as uncontrolled heavy menstrual bleeding, for which surgery is going to help.


Last updated 02.06.2005

Oh i have big breasts doc? can i have operation...?

Large breasts
Written by Dr Erik Fangel Poulsen, specialist

How do breasts change throughout your life?

Breasts develop differently from woman to woman, and their shape and size changes throughout life.

Each month, you may feel a tension and swelling in your breasts before your period is due. This sensation disappears as soon as your period begins.

Pregnancy and birth is a time of breast growth, when the milk glands develop and milk is produced. Once breastfeeding is stopped, your breasts will change shape again.

Later in life the size of the glands decreases whereas the fat content increases. This causes some women's breasts to grow larger, while others experience the opposite effect.

Breasts and body image

A great many women dislike the appearance and size of their breasts. This is, of course, connected to our culture.

Breasts are seen as a crucial part of any woman's sexual appeal. In newspapers, magazines and on TV and films, we are confronted with images of what is regarded as the ideal bosom.

Consciously or unconsciously, some women wish their breasts matched this 'ideal'. Just as those with AA cups can yearn to be larger, so those with E cups can wish for a smaller bust.

Problems associated with large breasts

Even young women who have never been pregnant can feel that their breasts are too large and causing them a significant problem.

You may feel self-conscious wearing certain kinds of clothes or be embarrassed about undressing at the gym or in communal changing rooms when shopping.

A good supportive bra can be a great help, but if your breasts are very heavy, the bra straps may cut deep into your shoulders. Your posture will be affected and you may have aching muscles in your chest and shoulders.

What can be done to help?

If you are unhappy with the size of your breasts, consult your doctor who will be able to assess whether breast-reduction surgery is a suitable option. If so, the doctor will refer you to a hospital or cosmetic surgeon with experience of such operations.

What happens in the operation?

The surgeon will first remove an amount of breast tissue and skin.

The nipples stay connected to the remaining gland and fatty tissue, but are moved upwards on the wall of the breast. A circular piece of skin is removed from a suitable area.

This method is used for both large and pendulous breasts.

The results of these operations are almost always very good, with the surgeon aiming not only to reduce the size of the breast but to make sure you are happy with their new appearance.


Last updated 02.03.2005

Antioxidants for stress....can i get from the fruit doc?

Antioxidants and oxidative stress
Written by Dr Dan Rutherford, GP

What is oxidative stress?

Your body constantly reacts with oxygen as you breathe and your cells produce energy. As a consequence of this activity, highly reactive molecules are produced known as free radicals.

Free radicals interact with other molecules within cells. This can cause oxidative damage to proteins, membranes and genes.

Oxidative damage has been implicated in the cause of many diseases such as cancer and Alzheimer's and has an impact on the body's aging process.

External factors such as pollution, sunlight and smoking also trigger the production of free radicals.

Antioxidants

To counteract oxidative stress, the body produces an armoury of antioxidants to defend itself. It's the job of antioxidants to neutralise or 'mop up' free radicals that can harm our cells.

Your body's ability to produce antioxidants (its metabolic process) is controlled by your genetic makeup and influenced by your exposure to environmental factors such as diet and smoking.

Changes in our lifestyles, which include more environmental pollution and less quality in our diets, mean that we are exposed to more free radicals than ever before.

How much do I need?

Your body's internal production of antioxidants is not enough to neutralise all the free radicals.

You can help your body to defend itself by increasing your dietary intake of antioxidants.

Examples of food-based antioxidants


Antioxidant supplements
Studies have shown that antioxidants supplements do not replicate the action of antioxidants from food.
More research is needed before, say, Vitamin C supplements can be advised to prevent cancer.
o Vitamins: vitamin E, vitamin C and beta carotene.

o Trace elements that are components of antioxidant enzymes such as selenium, copper, zinc, and manganese.

o Non-nutrients such as ubiquinone (coenzyme Q) and phenolic compounds such as phytoestrogens, flavonoids, phenolic acids and butylated hydroxytoluene (BHT), which is used as a food preservative.


Foods and antioxidants

Tomatoes

Tomatoes contain a pigment called lycopene that is responsible for their red colour but is also a powerful antioxidant.

Tomatoes in all their forms are a major source of lycopene, including tomato products like canned tomatoes, tomato soup, tomato juice and even ketchup.

Lycopene is also highly concentrated in watermelon.

Citrus fruits

Oranges, grapefruit, lemons and limes possess many natural substances that appear to be important in disease protection, such as carotenoids, flavonoids, terpenes, limonoids and coumarins.

Together these phytochemicals act more powerfully than if they were given separately.

It's always better to eat the fruit whole in its natural form, because some of the potency is lost when the juice is extracted.

Tea

Black tea, green tea and oolong teas have antioxidant properties. All three varieties come from the plant Camellia sinenis.

Common brands of black tea do contain antioxidants, but by far the most potent source is green tea (jasmine tea) which contains the antioxidant catechin.

o Black tea has only 10 per cent as many antioxidants as green tea.

o Oolong tea has 40 per cent as many antioxidants as green tea.


This because some of the catechins are destroyed when green tea is processed (baked and fermented) to make black tea.

Carrots

Beta-carotene is an orange pigment that was isolated from carrots 150 years ago.

It is found concentrated in deep orange and green vegetables (the green chlorophyll covers up the orange pigment).

Beta-carotene is an antioxidant that has been much discussed in connection with lung cancer rates. The evidence is conflicting, with one study showing an increase in risk, but further research is being done to see if it has a protective effect.

Will eating antioxidants really protect me from disease?

Studies have shown that people who eat a diet that is rich in fruit and vegetables are less likely to get diseases such as cancer, heart disease and stroke.

It has not yet been proven that antioxidants alone are responsible for this drop in risk.

For example, the research that has been done on the effect of diet on cancer has been difficult to conduct and interpret.

Even so, there is now a good body of evidence to indicate the protective effect of fruit and vegetables on many common cancers, including those of colon, breast and bladder.

Other articles on antioxidants

* Fruit and vegetables

* Antioxidants - tips for healthy living

should i use contraception . doc?..can i still get pregnant....?

Frequently asked questions on contraception
Written by Dr David Delvin, GP and family planning specialist


© NetDoctor/Geir - FAQs on contraception
Only use condoms that carry the European CE mark or the BSI Kitemark BS EN 600.
A lot of the emails we receive about contraception are from people who are too embarrassed to raise their questions with their GPs. Here, I present a sample of the most common queries - beginning with some that arrive regularly from younger people.

My mates say that condoms are dangerous to use, because they break. Are they right?

No. Condoms do break occasionally, but this is unlikely if you handle them gently, and don’t snag them with your fingernails or jewellery.

It’s recently become clear that a lot of females who ask for the morning after pill say the condom broke - because they don’t want to admit that they didn’t use one.

This has helped to give condoms a false reputation for breaking.

Even if one in a thousand condoms breaks, that’s still far, far better than the risks of not using one at all.

Is it true that you can’t get pregnant the first time you do it?

This is a dangerous myth that has been responsible for a lot of unwanted pregnancies.

You can get pregnant the first time you have sex, and it has happened to many, many young women.

You might get away with it, because the chance of getting pregnant from a single act of sex is around one in 20. But it really isn’t worth taking the risk.

If you’re going to do it, use a reliable method of contraception.

A friend has told me that you can’t get pregnant if you do it standing up. Is there any truth in this?

None whatsoever. You can get pregnant in any position.

My boyfriend says we don’t need contraception, because he will pull out at the last minute. Is this a good idea?

Not really. ‘Withdrawal', or coitus interruptus as it’s known, is not a good way to avoid pregnancy – partly because boys leak sperm before they come

I have heard that women can only get pregnant during a certain part of the menstrual cycle. Could my partner and I have unprotected sex if we avoid these ‘dangerous’ times of the month?

I really wouldn’t advise this, particularly if you don’t know much about what you’re doing.

It is true that women are usually at their most fertile during the middle part of their cycle. This is about 12 to 14 days after the start of a period.

Women are generally at their least fertile just before menstruation, during menstruation, and just after menstruation.

But it's still possible to fall pregnant and your monthly cycle can change. Frankly, it’s a gamble.

If you want to use the rhythm method or natural family planning, as it's known, seek advice from an experienced health professional.

I am thinking of trying the Pill, but my mother says it’s dangerous for younger women.

I’m afraid she has this the wrong way round. The risks of the Pill aren’t all that big, but they’re much greater in older women.

In the age group 16 to 30, the danger of serious side-effects from the Pill is very small – unless you are a smoker or have other risk factors such as a history of thrombosis (clots), or a family history of relatives who had heart attacks or strokes at an early age.

You will be asked about these things when you first go to a doc to obtain the Pill. She will also check your blood pressure – because a raised BP does increase the risk of complications from the Pill.

Does the Pill turn women off sex?

No, this is largely a fantasy. Most women become more keen on sex because they know the Pill is giving them excellent protection against unwanted pregnancy.

A very small number of women say the Pill reduces their libido.

If you find this is the case, it’s always worth changing to another of the 22 brands that are available in the UK.

What methods of contraception are reliable?

There are 12 methods of contraception that you can regard as highly dependable.

o The Pill.

o The mini-Pill.

o The patch (Evra).

o The IUD (the coil).

o The IUS (Mirena).

o The injection.

o The implant.

o The condom.

o The diaphragm and the cap.

o Vasectomy (male sterilisation).

o Female sterilisation.

o Natural family planning if taught by a properly qualified professional.


All these methods do carry a small failure rate – nothing is 100 per cent effective. But each of these options is an awful lot better than just crossing your fingers and hoping for the best.

What about spermicides? Are they effective?

Spermicidal creams, foams, pessaries and sponges are no longer considered effective enough on their own.

What is the best method of contraception?

Quite a few couples come into my clinic asking this question, but there isn't a best method of family planning. What matters is what works for you.

Different things suit different people. If it’s any help, the two most popular methods in the UK are the Pill and male condom.

Vasectomy and female sterilisation are popular with people who don’t want any more children, but they have become more difficult to obtain free under the cash-strapped NHS.

A lot of people now get these operations from contraception charities such as Marie Stopes (£990 for female sterilisation, £395 for vasectomy).

What about new forms of contraception? Are they likely?

It is probable that new methods of contraception such as the vaginal ring will soon become available. However, the much hyped ‘male Pill’ is unlikely to be on the market within the next few years.

Further information

If you've more questions, talk to a nurse or doctor who’s been specially trained in contraception – eg at a family planning clinic, Brook Advisory Centre for young people or GP surgery.

masturbation....good or not ? will this make a problem?

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penis size....size matters...should i get operated to have big sizes?

Facts about penis size
Written by Dr David Delvin, GP and family planning specialist and Christine Webber, psychotherapist

Even in this supposedly enlightened century, men fret about penis size. Though the vast majority of guys have more than enough bulk to perform well as lovers, there is a widespread masculine obsession that 'more would be better'.

We get a constant flow of emails and letters from males who are worried that they are 'too small'. Vast sums of money can be made by exploiting this obsession, but other than surgery, there is little that is clinically proven to increase penis size.

Any woman reading this article may find it puzzling that so many men are concerned about the length of their penis and wish they had 'just a couple of inches more'. But that's the way that a lot of men are.

Size matters

To the average man, his penis is, consciously or unconsciously, one of the most important things in the whole world. At an early age he discovers it and immediately becomes fascinated by it.

But then a note of uncertainty enters his mind: 'Isn't mine rather small?' Look at Dad's, look at big brother's, look at those in the men's changing room - and he asks himself if he will be as big as that.

And so he goes on through life, always a tiny bit sensitive about the size of his organ, always convinced that it would be nicer if it were just that little bit longer.

No matter how often it's written that penile size doesn't matter, and that women aren't attracted to a man because of the length of his organ, the average male continues to think the same way.

The average female cannot understand this obsession with penile measurement. So if you're a woman, never belittle a man's penis in bed, even as a joke, or say anything to indicate that you think it's small. The guy may take you seriously, and if he does, he'll be deeply hurt.

We have known men who have gone on to have problems with impotence (erectile dysfunction) after someone made an unthinking remark about their dimensions. But almost all of these men had a perfectly normal male organ. Each one just thought he was very small compared with other men.

A question of perspective

The trouble is that every man sees his own penis in a foreshortened view. The angle at which you look down inevitably makes your penis seem shorter than it is.

But when you glance at another man's organ, there's no such foreshortening effect, so very often it'll look as though the other guy is slightly better endowed.

A lifetime of comparison of this sort (and virtually every male does a quick mental check on each naked man he sees) can easily make you feel a bit inadequate. But it's important to realise the facts about penis length.

Average penis length

A non-erect penis usually measures between 8.5cm and 10.5cm (3-4 inches) from tip to base.

The average figure is about 9.5cm (3.75 inches), but this kind of precise measurement is rather valueless. Many factors can cause a temporary shrinkage of two inches or more, for instance cold weather or going swimming, so you needn't worry if you happen to fall short of the average figure.

Of course, it's true that some men have big penises and some have smaller ones, just as some men have small feet and some have big feet, but the measurement is not - repeat not - an index of virility.

Most people think that a tall man will usually have a large penis, but this is not true. The distinguished American researchers Masters and Johnson measured the penile lengths of more than 300 men.

* The largest organ was 14 cm (5.5 inches) in the flaccid state. It belonged to a slim man who was 5' 7" tall (170 cm).

* The smallest penis measured 6cm (2.25 inches). It belonged to a fairly heavily built man of 5' 11" (180cm).

It's also worth pointing out that there is no correlation between penile size and race.

Average size of erections

We've talked about the length of the penis in its ordinary non-erect state, but how long should it be when it's erect?

Interestingly, most penises are very much the same size when erect.

* The man whose non-erect penis is smallish will usually achieve about a 100 per cent increase in length during sexual excitement.

* The man whose non-erect penis is on the largish size will probably manage about a 75 per cent increase.

* This means the great majority of penises measure between 15cm and 18cm (6-7 inches) when erect, with the average figure being about 16.5cm (6.5 inches).

So you can see that even if a man has got a 'small' penis, he's got a built-in compensating factor that will bring him up to about the same size as the guy who appears to be 'better equipped' in the shower room.

Sex and women

Virtually every man forgets that it doesn't matter how long or how short your penis is, because the vagina will accommodate itself to any length.

* The vagina of a woman who hasn't had a child is only 7.5cm (3 inches) long when she's not sexually excited. The figures for women who have had babies are only slightly different.

* Even when aroused, a woman's vagina usually extends only to a length of about 10cm (4 inches).

This means any man's penis will fill her vagina completely, unless you happen to be one of those rare guys with an erect penile length of less than four inches.

You're probably now wondering how the average man with an erection of six inches manages to insert his penis into the vagina at all.

The vagina has the most remarkable capacity for lengthening if something is introduced into it gradually.

So the exceptional man whose erect penis is eight inches long can still make love to any woman, providing he excites her properly and introduces his organ very slowly. If he does this, her vagina will lengthen by 150 or 200 per cent to accommodate him.

What if I'm not happy about my penis size?

If you're really worried that your penis is the wrong size, go and see your doctor.

If you're not happy about consulting your GP on such an intimate matter, you could see one of the medics who spend their entire day checking men's penises. You can find these doctors at:

* private 'well-man' clinics, but take care: a few of these are run by quacks

* NHS urology clinics

* NHS sexual medicine clinics

* NHS genitourinary medicine (GUM) clinics

* NHS family planning clinics, although these tend to be oriented towards women and don’t have much time to deal with males.

* Brook advisory clinics (for the under 25s).

What treatments are there to increase penis size?

Many companies claim they know how to enlarge your penis - for a price.

We have been to several medical conferences this year at which leading experts have spoken about penis size and penis enlargement.

Their opinions on the various methods that are so widely advertised to the public can be summed up as follows.

* Pills or patches for increasing penis size: a complete waste of time.

* Penile enlargement surgery: of uncertain value and sometimes dangerous.

* Penile enlargement exercises: probably pretty futile.

* Penile suction devices: probably of little use.

Several European experts say that the relatively new stretcher or extender devices may sometimes be of value in giving a man a little extra length.

Surgery to increase penis size

A number of private clinics now offer operations that claim to make the penis look bigger. The expense of this type of surgery is very great and there is a risk of complications like bleeding, infection or deformity.

One surgical procedure that has become popular since 2005 is slicing through the ligament that supports the penis.

This makes the penis dangle more, so it looks longer when not erect. But it will make no difference to the size of your erection - and it won’t come up as high as it used to before the op.

Another type of surgery involves injecting your own fat into your penis to make it more bulky. This may not work, and it can lead to complications.

We recommend that you do not agree to undergo any surgery unless you have seen an NHS consultant urologist who feels that you really need it.

Penis stretchers (extenders)

Some urologists are beginning to use a special extending frame to try to stretch the penis.

These ‘stretchers’ are small rectangular frames that you wear on your penis for hours at a time, every day. They pull your organ out to its maximum length, and the idea is that it will gradually remain longer.

The devices are said to be undetectable under trousers.

There have been several reports from Italy and Spain by surgeons who claim a modest degree of improvement in length from this kind of traction.

We don't think these devices are some sort of miracle discovery, but one surgeon reported that a group of men achieved an average increase in length of 1.8cm after using the device daily for four months. This is less than three-quarters of an inch, but for some men this would be significant.

Stretchers cost between £150 and £200.

What treatments are there to reduce penis size?

Occasionally, a man with a big penis feels that he wants it reduced in size. This can be done, but there is quite a risk that the operation might go wrong.

Again, we advise you not to have this operation unless an NHS consultant urologist has said it is necessary.

diet ..diet...diet MYTH..............why i m fat, why.....i have to be like model?

Top 10 diet myths
Written by Elizabeth Openshaw, health journalist

Need to lose weight? Before you give up the late night munching and go on a no-fat detox frenzy to kick your sluggish metabolism into shape, read what the experts have to say about these popular dieting myths.

Myth 1

Myth

Low-fat or no-fat diets are good for you.


© PhotoDisc - top diet myths
A low-fat diet can help weight loss, but don't cut out fat altogether.

Fact

Leading dietician Lyndel Costain says: 'People tend to think they need a low-fat diet to lose weight, but you should still have a third of your calories coming from fat.'

The body needs fat for energy, tissue repair and to transport vitamins A, D, E and K around the body.

Lyndel Costain adds: 'As a guideline, women need 70g of fat a day (95g for men) with 30g as the minimum (40g for men).

'There's no need to follow a fat-free diet. Cutting down on saturated fats and eating unsaturated fats, found in things like olive oil and avocados, will help.'

Myth 2

Myth

Crash dieting or fasting makes you lose weight.

Fact

This may be true in the short term, but ultimately it can hinder weight loss.

Claire MacEvilly, a nutritionist at the MRC Human Nutrition Research Centre in Cambridge, explains: 'Losing weight over the long term burns off fat. Crash dieting or fasting not only removes fat but also lean muscle and tissue.'

The loss of lean muscle causes a fall in your basal metabolic rate - the amount of calories your body needs on a daily basis.

This means your body will need fewer calories than it did previously, making weight gain more likely once you stop dieting.

It's also why exercise is recommended in any weight-loss plan to build muscle and maintain your metabolic rate.

Claire MacEvilly adds: 'Fasting can also make you feel dizzy or weak so it's much better to try long-term weight loss.'

Myth 3

Myth

Food eaten late at night is more fattening.

Fact

Many diets tell you not to eat after a certain time in the evening. They say the body will store more fat because it is not burned off with any activity.

A study at the Dunn Nutrition Centre in Cambridge suggests otherwise.

Volunteers were placed in a whole body calorimeter, which measures calories burned and stored.

They were fed with a large lunch and small evening meal for one test period, then a small lunch and large evening meal during a second test period.

The results revealed the large meal eaten late at night did not make the body store more fat.

It's not when you eat that's important, but the total amount you consume in a 24-hour period.

Lyndel Costain adds: 'It is true that people who skip meals during the day, then eat loads in the evening are more likely to be overweight than those who eat regularly throughout the day.

'This may be because eating regular meals helps people regulate their appetite and overall food intake.'

Myth 4

Myth

A slow metabolism prevents weight loss.

Fact

This is a common myth among dieters who are struggling to lose weight.

Studies have shown that resting metabolism - the number of calories used by the body at rest - increases as people become fatter.

In other words, the larger you are, the more calories you need to keep your body going and the higher your metabolism.

Clare Grace, research dietitian at the Queen Mary University of London, says: 'Weight gain occurs when the number of calories eaten is greater than the number used up by the body.

'Unfortunately, people are becoming increasingly sedentary, burning off less and less calories, and it seems likely this is a crucial factor in the increasing numbers struggling to control their weight.'

Myth 5

Myth

Fattening foods equal rapid weight gain.

Fact

Believe it or not, true weight gain is a slow process. You need to eat an extra 3500 calories to gain one pound of body fat (and vice versa for losing it).

Lyndel Costain explains: 'If the scales say you've gained a few pounds after a meal out, it's largely due to fluid, which will resolve itself - as long as you don't get fed up, and keep overeating!

'A lot of people feel guilty and think they've blown their diet if they eat rich foods. But, how can a 50g chocolate bar make you instantly put on pounds?

'For long-term weight control, balance high-fat foods with healthy food and activity.'

Myth 6

Myth

Low-fat milk has less calcium than full-fat milk.

Fact

Skimmed and semi-skimmed milk actually have more calcium, says dietician Alison Sullivan, because the calcium is in the watery part, not the creamy part.

She says: 'If you're trying to lose weight and cut fat from your diet, skimmed milk is your best bet because it is lower in fat and has 10mg more calcium per 200ml milk than full fat.

'Semi-skimmed is best for maintaining a healthy lifestyle if you're not dieting.

'Full-fat milk is best for children and adults who are underweight.'

Myth 7

Myth

Low-fat foods help you lose weight.

Fact

'Low-fat' or 'fat-free' doesn't necessarily mean low calorie or calorie-free, warns Lyndel Costain.

Check the calorie content of foods, especially cakes, biscuits, crisps, ice creams and ready meals.

Extra sugars and thickeners are often added to boost flavour and texture, so calorie content may be only a bit less, or similar to standard products.

Foods labelled low-fat should contain no more than 3g fat per 100g.

'Watching the quantity is important,' adds nutritionist Alison Sullivan. 'People tend to have half-fat spread but then use twice as much.

'And things like fruit pastilles may be low in fat, but are high in sugar which turns to fat.

'With low fat foods, look to see where else the calories might come from.'

Myth 8

Myth

Cholesterol is bad for you.

Fact

Cholesterol is a fatty substance that is made mostly by the liver.

It can be bad for us, because it forms deposits that line and clog our arteries. Clogged arteries contribute to heart disease.

But we all need some blood cholesterol because it's used to build cells and make vital hormones - and there's good and bad cholesterol.

Lyndel Costain explains: 'Saturated fats found in food like meat, cheese, cream, butter and processed pastries tend to raise low density lipoprotein (LDL) cholesterol, known as 'bad' cholesterol, which delivers cholesterol to the arteries.

'High density lipoprotein (HDL), or 'good' cholesterol, transports cholesterol away from the arteries, back to the liver.'

So choose unsaturated fats such as vegetable oils, nuts and seeds.

Myth 9


Banana myth
Many people believe bananas are fattening.
Bananas are low in fat and are packed with potassium.
There is only 0.5g fat and 95 calories in a banana.

Myth

Vegetarians can't build muscle.

Fact

Vegetarians can be as muscular as meat eaters by getting their protein from vegetable sources such as cheese, nuts, pulses and grains.

Claire MacEvilly says: 'You need protein to build muscle, but too much can lead to long-term side effects.

'The body can only store a certain amount of protein, so too much can damage the kidney.

'The Department of Health recommends that 50 per cent of energy should come from carbohydrates, 35 per cent from fat and the remaining 15 per cent from protein.'

Myth 10

Myth

You always gain weight when you stop smoking.

Fact

Some people gain weight when they stop smoking, some lose weight and some stay the same.

While nicotine does increase the body's metabolism, its effect is small. It's far healthier to be an overweight non-smoker than not bother giving up because you think you'll put on weight.

Alison Sullivan says: 'Where people tend to fall down is when they replace a cigarette with comfort food.

'Chewing sugar-free gum or snacking on vegetable strips kept in the fridge is a good idea because you can have these instead of reaching for the biscuit tin.

'And something like a satsuma keeps your hands occupied until the craving goes away.'


Last updated 25.07.2007

why i have small breasts.....doc?

Small breasts
Reviewed by Dr Dan Rutherford, GP

Breasts not only develop differently from woman to woman, they continue to change shape and size throughout your life. The right breast may not even be the same size as the left.

Breasts can start developing from the age of 10. They continue to grow and change shape throughout puberty.

Their final shape and size depends more or less on inherited characteristics, but a mother and daughter's breasts can develop completely differently.

Is it possible to change the size of my breasts?

One thing is common for all women: there is no medicine of any kind, no work-out machine or exercise that will significantly change the shape or size of your breasts.

Only in special medical cases can a hormone supplement be used to make breasts grow.

Birth control pills may give the feeling of a larger bosom, but it's only in pregnancy and when breastfeeding that your breasts may grow visibly.

Are silicone implants an option?

If you are very unhappy with your breast size or shape, or have had part of a breast removed as a result of cancer, you may decide to have silicone implants.

For many it is a costly and often painful operation, but it is becoming more common. Plastic surgeons have become very skilful in this field, so the results are usually satisfactory.

However, there have been several health scares as a result of implants. Some women claim the silicone has leaked and caused related health problems, but these claims have not been medically proven.

How is the operation performed?

The implants are placed on the chest under the muscles, which leaves the breast tissue untouched and also means that the nipples will stay in natural contact with the gland tissue.

The implants are inserted under the skin, with the exact location depending on the size and shape of the breasts.

Some women go to hospital for the operation, whereas others are treated as outpatients but rely on receiving rest and care at home. The operation is performed under full anaesthetic.

How much do implants cost?

Most women have to pay for the operation, but it can also be done under the NHS when the need arises following breast surgery, perhaps for cancer.

Also, if you are very distressed by your breast size and it is judged that an operation is the best method to deal with your distress, it can be done via the NHS. Nevertheless, the waiting time is likely to be long.

An average cost for a private operation in the UK is usually between £2,500 and £4,000. Always make sure your surgeon is registered with The Association of Cosmetic Surgeons - ask your own doctor first, who will give advice and guidance.

Based on a text by Dr Erik Fangel Poulsen, specialist

Last updated 16.02.2005

ovarian cancer. be careful ladies....!

Ovarian cancer
Reviewed by Dr Paul Klenerman, consultant physician and infection specialist

What is ovarian cancer?

Women have two ovaries, one on each side of the uterus (womb), situated relatively close to the Fallopian tubes.

The ovaries are fairly loosely connected and able to move in relation to their surroundings. Normal ovaries are smooth, oval and measure no more than a couple of centimetres in diameter - slightly more if measured lengthwise.

Most ovarian tumours are benign and remain so. However, some may later become malignant or cancerous. Others are malignant from the beginning.

Some ovarian cancers have spread (metastasised) from cancers originating in other organs of the body.

Who is most at risk of ovarian cancer?

Ovarian cancer is most common in menopausal women (over 50 years of age). It is rare in women under 40.

As far as we know, ovarian cancer cannot be prevented. But women who have used oral contraceptives in the past have a reduced risk of ovarian cancer compared to women who have never used them.

Rarely, ovarian cancer can run in families and there may be a genetic defect to explain this. Genetic counselling and testing is available from specialist centres.

What are the symptoms of ovarian cancer?

The symptoms of ovarian cancer are not specific to ovarian cancer and this often results in a late diagnosis of the disease.

The cancer has often spread throughout the pelvis and abdomen by this time, and is therefore more difficult to treat successfully.

Ovarian cancer may be discovered by chance during a routine gynaecological examination or it may be discovered because the tumour has grown so large that you can feel it, or because it is pressing on the bladder or intestines.

Other symptoms can include an expanding waistline due to the collection of fluid within the abdomen from the cancer.

How is ovarian cancer diagnosed?

The only certain means of diagnosis are either an operation or a biopsy taken during a special procedure called a laparoscopy. Ultrasound examination is a very useful tool since it enables a doctor to identify an ovarian tumour and certain features that might make him or her suspect a cancer.

A blood test can detect substances produced from the ovarian cancer and these substance are useful in monitoring the course of the disease.

All cysts or tumours over a certain size that are discovered during an examination should be removed - or a biopsy should be carried out so that an accurate diagnosis can be made.

The size of the growth is not the sole indication of whether it is cancerous or not. Ovarian cysts can be quite large, yet completely benign (non-cancerous).

How is ovarian cancer treated?

This will depend upon a number of factors including the extent of the tumour and the age of the woman. Most women will be advised to undergo surgery to remove the uterus, both Fallopian tubes and ovaries.

If the cancer is at an early stage, no further treatment may be necessary. However, the majority of women will be advised to undergo chemotherapy in addition to their surgery.

Cure rates vary enormously according to the extent of the cancer, stage of the disease, tissue type of the cancer as well as the woman's age and general health.

Based on a text by Dr Erik Fangel Poulsen, specialist and Dr Per Grinsted

Last updated 01.05.2005