Hypertension: Introduction.

Hypertension is one of the most serious concerns of modern medical practice. It is estimated that in the United States, as many as 60 million people are hypertensive or are being treated with antihypertensive drugs. Among the growing population of elderly Americans, some 15 million have high blood pressure.

The level of blood pressure in itself is not a chief concern, since individuals with high blood pressure may be asymptomatic for many years.What is of prime significance is that hypertension has been shown convincingly to be the single most important contributing factor to cardiovascular disease, the leading cause of morbidity and untimely death in the United States.

The actual level of pressure that can be considered hypertensive is difficult to define; it depends on a number of factors, including the patient’s age, sex, race, and lifestyle. As a working definition, many cardiovascular treatment centers consider that a diastolic pressure of 90 mm Hg or higher or a systolic pressure of 140 mm Hg or higher represents hypertension.

Hypertension is considered to be:

*Stage I, or mild, if diastolic pressure is 90 to 99 mm Hg and/or systolic pressure is 140 to 159 mm Hg.
*Stage II, or moderate, hypertension is diastolic pressure of l00 to 109 mm Hg and/or systolic pressure of 160 to 179 mm Hg.

*Stage III, or severe, hypertension exists when diastolic pressure is 110 mm Hg or greater and/or systolic pressure is 180 mm Hg or greater.

These values should not be considered as absolutes but rather as indicators for facilitating discussion, particularly in relation to the indications for use of specific drugs. Since in general terms hypertension can be defined as the level of blood pressure at which there is risk, the ultimate judgment concerning the severity of hypertension in any given individual must also include a consideration of factors other than diastolic or systolic pressure.

The aim of therapy is straightforward: reduction of blood pressure to within the normal range.When hypertension is secondary to a known organic disease, such as renovascular disease or pheochromocytoma, therapy is directed toward correction of the underlying malady.

Unfortunately, about 90% of cases of hypertension are of unknown etiology. The therapy of primary, or essential hypertension, as these cases are generally called, is often empirical. There are three general approaches to the pharmacological treatment of primary hypertension.

The first involves the use of diuretics to reduce blood volume.
The second employs drugs that interfere with the renin–angiotensin system, and
The third is aimed at a drug-induced reduction in peripheral vascular resistance, cardiac output, or both.

A reduction in peripheral vascular resistance can be achieved directly by relaxing vascular smooth muscle with drugs known as vasodilators or indirectly by modifying the activity of the sympathetic nervous system.

Female Sexual Dysfunction: Vaginismus, Kegel exercises

Kegel exercises

Kegel (KAY-gul or KEY-gul) exercises strengthen the pelvic floor muscles, which support the uterus, bladder and bowel. It takes diligence to identify your pelvic floor muscles and learn how to contract and relax them. Here are some pointers:

Find the right muscles

 

To make sure you know how to contract your pelvic floor muscles, try to stop the flow of urine while you're going to the bathroom. If you succeed, you've got the basic move. Or try another technique: Insert a finger inside your vagina and try to squeeze the surrounding muscles. You should be able to feel your vagina tighten and your pelvic floor move upward. Then relax your muscles and feel your pelvic floor move down to the starting position. As your muscles become stronger — and you become more experienced with the exercises — this movement will be more pronounced.

But don't make a habit of starting and stopping your urine stream. Doing Kegel exercises with a full bladder or while emptying your bladder can actually weaken the muscles. It can also lead to incomplete emptying of the bladder, which increases your risk of a urinary tract infection.

If you're having trouble finding the right muscles, don't be embarrassed to ask for help. Your doctor or other health care provider can give you important feedback so that you learn to isolate and exercise the correct muscles.

   

Once you've identified your pelvic floor muscles, empty your bladder and sit or lie down. Then:

• Contract your pelvic floor muscles.


• Hold the contraction for three seconds then relax for three seconds.


• Repeat 10 times.


• Once you've perfected three-second muscle contractions, try it for four seconds at a time, alternating muscle contractions with a four-second rest period.


• Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

To get the maximum benefit, focus on tightening only your pelvic floor muscles or isolating your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Also, try not to hold your breath. Just relax, breathe freely and focus on tightening the muscles around your vagina and rectum.

Repeat three times a day

 

Perform a set of 10 Kegel exercises three times a day. The exercises will get easier the more often you do them. You might make a practice of fitting in a set every time you do a routine task, such as checking e-mail or commuting to work.

Vary your technique with one of these methods:

• Try sets of mini-Kegels. Count quickly to 10 or 20, contracting and relaxing your pelvic floor muscles each time you say a number.


• Visualize an elevator. Slow down the exercises, gradually contracting and releasing your pelvic floor muscles one at a time. As you contract, visualize an elevator traveling up four floors. At each floor, contract your muscles a little more until you reach maximum contraction at the fourth floor. Hold the contraction and then slowly release the tension as you visualize the elevator returning to the ground floor. Repeat 10 times.

Biofeedback training

If you have trouble doing Kegel exercises, biofeedback training may help. In a biofeedback session, a nurse, therapist or technician will either insert a small monitoring probe into your vagina or place adhesive electrodes on the skin outside your vagina or rectal area. When you contract your pelvic floor muscles, you'll see a measurement on a monitor that lets you know whether you've successfully contracted the right muscles. You'll also be able to see how long you hold the contraction.

Another technique uses electrical stimulation to help you feel the muscles contract. The procedure is painless, although you'll experience a buzzing feeling as a small electrical current is applied to your pelvic floor muscles, making them contract. Once you feel this sensation a few times, you'll probably be able to duplicate the exercise on your own. Because simpler methods work for most women, this technique is rarely used. 

 

Female Sexual Dysfunction: Vaginismus, Treatment

Vaginismus is considered one of the most successfully treatable female sexual disorder. Many studies have shown treatment success rates approaching nearly 100%. Treatment resolution follows a manageable, step-by-step process.

Vaginismus is highly treatable. Successful vaginismus treatment does not require drugs, surgery, hypnosis, nor any other complex invasive technique. Effective treatment approaches combine pelvic floor control exercises, insertion or dilation training, pain elimination techniques, transition steps, and exercises designed to help women identify, express and resolve any contributing emotional components. Treatment steps can often be completed at home, allowing a woman to work at her own pace in privacy, or in cooperation with her health care provider.

• The sexual pain, tightness and penetration difficulties from vaginismus are fully treatable and can be completely overcome with no remaining pain or discomfort.
• Women experiencing sexual tightness/pain, penetration problems, or unconsummated relationships can expect remarkable resolution of their vaginismus, allowing full, pain-free intercourse.
• Treatment steps can usually be completed at home using a self-help approach, allowing a woman to work at her own pace in privacy, or in cooperation with her health care provider or specialist.
• Vaginismus treatment exercises follow a manageable, step-by-step process.

Treatment involves extensive therapy that combines education, counseling, and behavioral exercises. Such exercises include pelvic floor muscle contraction and relaxation (Kegel exercises).

Vaginal dilation exercises are recommended using plastic dilators. This should be done under the direction of a sex therapist or other health care provider. Such therapy should involve the partner, and can gradually include more intimate contact, ultimately resulting in intercourse.

Educational resources should be provided. This includes information about sexual anatomy, physiology, the sexual response cycle, and common myths about sex.