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The condition known as hypothyroidism is when the thyroid gland does not function properly. This results in the body having reduced levels of thyroid hormone in it. Dry skin, hair loss, hoarseness, excessive menstruation, fatigue, lethargy, depression, intolerance to cold, constipation and weight gain are all symptoms of hypothyroidism. There are different causes of hypothyroidism, cretinism is a type of hypothyroidism that develops at birth and results in stunted growth and mental development. A common cause of hypothyroidism is Hashimoto’s thyroiditis which is an autoimmune disease of the thyroid gland. Damage done during radiation treatment or surgery to the thyroid gland to treat hyperthyroidism (an over active thyroid gland) is another common cause of hypothyroidism. Also some drugs, such as phenylbutazone and lithium, sometimes also cause hypothyroidism. Some people with an enlargement of the thyroid gland which is known as goitre have hypothyroidism. This is cause by an iodine deficiency which could be the result of eating too many foods that contain goitrogens such as rapeseed, cabbage, Brussels sprouts, broccoli, and cauliflower or by another disorder that effects the thyroid hormone production. A condition known as secondary hypothyroidism is cause by the hypothalamus or pituitary gland not stimulating the thyroid gland properly. Severe hypothyroidism is called myxedema. Extreme iodine deficiency is another possible cause of hypothyroidism but this is rare. Medical treatment of hypothyroidism consists of prescribing synthetic thyroid or desiccated thyroid hormone. Naturopathic practitioners like to use desiccated natural thyroid complete with all thyroid hormones. Thyroid hormone replacement is necessary in most cases of hypothyroidism. Changing the diet will help with hypothyroidism. Eating goitrogenic foods such as rapeseed, cabbage, Brussels sprouts, broccoli, cauliflower, sweet potatoes, maize, lima beans, soya and pearl millet should be limited. These foods contain natural goitrogens, which are chemicals that cause the enlargement of the thyroid gland by interfering with thyroid hormone synthesis. Cooking is known to make the goitrogens elements less effective but it would be wise not eat these foods raw. Foods that contain iodine such as kelp, beetroot, radish, parsley, potatoes, fish, oatmeal and bananas should be kept in the diet. In the treatment of underactive thyroid, fats, sugars, sodium chloride, red meat and egg intake should also be restricted. The relationship between iodine and thyroid is complex, iodine is needed by the body to form thyroid hormone, and goitre and hypothyroidism can occur through iodine deficiency. Extreme and prolonged iodine deficiency can lead to serious types of hypothyroidism, such as cretinism or myxedema. On the other hand, consumption of excessive iodine intake can result in either hypothyroidism or hyperthyroidism. The amount of 150 mg that is usually in multi-mineral supplements should be enough to stop iodine deficiency but not enough to do harm. The amino acid tyrosine is an essential part of the thyroid hormones and neurotransmitters; this has been found to be deficient in people with hypothyroidism. Practitioners often recommended a low dose of thyroxine such as 1000mg to correct hypothyroidism. People with depression also have low levels of tyrosine, this is why it has be linked to hypothyroidism. Vitamin A, vitamin B2, vitamin B3, vitamin B6, vitamin C, and vitamin E are needed for the synthesis of thyroxine. The B vitamins and copper are vital co-factors for tyrosine metabolism. Copper, iron, selenium and zinc are essential in the production of T3 from T4. Some herbs can help combat hypothyroidism, nettle will balance the thyroid with both under and over activity. Bladderwrack (Fucus vesiculosus) is a type of brown seaweed that contains iodine. Hypothyroidism due to small intake of iodine may possibly improve with bladderwrack supplementation; also kelp has been linked to helping with hypothyroidism. Some people with hypothyroidism have seen improvements by taking Chinese herbs. Another aspect to look at is chemical sensitivities. Research has shown an association between hypothyroidism and multiple chemical sensitivities. It was found that people with exposure to toxic heavy metals, polybrominated biphenyls and cardon disulfides through their occupations suffered from depression, fatigue, poor memory and constipation which are all symptoms of hypothyroidism. Another important factor in the treatment of hypothyroidism is exercise. Exercise increases tissue sensitivity to the thyroid hormone and stimulates thyroid gland secretion. This is especially true in people who are dieting; this is because when dieting the metabolic rate decreases but exercise prevents this decline. An exercise regime of between 15-20 minutes per day will be beneficial with hypothyroidism. This exercise needs to be strenuous enough to raise the heartbeat, an exercise such as walking, swimming, running and cycling. In conclusion, to combat hypothyroidism, it is best not to consume foods high in goitrogens especially raw but to increase foods high in iodine in the diet, to exercise daily for 20 minutes, to supplement the diet with multiminerals and multivitamins, B complex, vitamin C, manganese, tyrosine, kelp and iodine and to check whether sensitivity to chemicals are causing hypothyroidism. Some Chinese herbs may also help. The following supplements may help if you are suffering from Hypothyroidism. B vitamins complex Manganese Multivitamin and multiminerals Vitamin C Tyrosine Kelp Iodine penis enargement surgeon permanent penis enargement enlargement manhattan pnis surgeon penis enlagement forum natural penis enlargment vimax penis enlargement exercise penile enlargement pic buy pennis enlargement pills
You may already have a regular training cycle. You may do EVERYTHING right when it comes to your diet. You may have tried some bodybuilding supplements, some Creatine, some Nitric Oxide. Are you getting the results you’re looking for? Are you getting results quickly? No? Then maybe you're ready to see your results skyrocket to levels you never dreamed possible. What if those lagging bodyparts burst into a whole new size and shape while your waistline shrunk with each passing week? If results like these are what you're lusting after then you need to learn the science behind stacking bodybuilding supplements. Stacking is really about understanding how the systems in your body work, what your own genetic limitations are and how to work around the limitations and use your knowledge to your benefit. For example, you may already know just how essential Creatine is to your muscle. It provides the essential substrates of energy you demand when every last fiber of your body is engaged in total training warfare during that last squat or deadlift. But you may not know that your own genetics might be stop you from using every last bit of that fuel when you need it most. That's right. BUT THERE IS A SOLUTION! – But I won’t tell you about it just yet. Another example. You may already know about the benefits of increased Growth Hormone like increased muscle cell density (hyperplasia) and increased fat loss. But did you know the pro's will never use it without running an anabolic like testosterone at the same time when they want to REALLY GAIN ANY MUSCLE and melt pounds of fat away at the same time? That's right, having one without the other is like an engine running without all its cylinders. For reasons like these and many more, that’s why your bodybuilding supplement program MUST focus on a precise combination of products that work together to enhance each other. Otherwise, you’ll never get the optimum results you want. The Basics of Building a Stack ANABOLICS – Step 1 A strong anabolic agent is the cornerstone to any cycle. All of these are intended to impact Testosterone or Nor-Andro in some way or another. Some bodybuilders use steroids, some prohormones or legal steroids although there are fewer of those available after the Ban. Here you’re looking for supplements that encourage dramatic gains in muscle and strength. Some can produce the addition of POUNDS of muscle during a cycle as well as an increase in strength during heavy lifts. Some can even alter the rate at which your muscle can absorb or assimilate Creatine into its cells. Which is where stacking comes in. A strong anabolic should always be paired with Creatine. And even better, with a product that also increases Nitric Oxide through the use of Arginine. CREATINE & NITRIC OXIDE – Step 2 Up until now, Creatine Monohydrate was about the best there was for feeding your muscles with the energy substrates they need to grow. Your muscles DEMAND Creatine after grueling workouts and for recuperation from long training sessions. Over 250 scientific studies prove Creatine's impact on muscle growth and strength but many people just weren't getting any results. The problem is, a lot of the Creatine you buy isn’t very bioavailable. Creatine monohydrate is SO unstable that when it's combined with ANY liquid, it converts almost immediately to a toxin called Creatinine. And that causes diarrhea, bloat and other digestive problems. In fact, it’s often so poorly absorbed that you may get only 20% of the Creatine before the rest converts to a waste product. So look for a product with more bioavailable Creatine. For even better results, find a Creatine product that also includes Nitric Oxide boosters. Nitric Oxide (NO) opens your blood vessels then speeds the livery of nutrients and muscle building agents like Creatine to give you extreme muscle growth, density and hardness. You can see how well that works with an anabolic. You put your body in high gear muscle building mode then enhance its ability to supply nutrients then furnish the nutrients. I’m sure you can see why this would make your hard work that much more effective. Think of your anabolic compound as the match that will light the bomb that is your Creatine Nitric Oxide compound.. Human Growth Hormone Releaser – Step 3 The purpose of HGH releasers are many. Increasing your HGH leads to a myriad of remarkable physical effects like fat-loss and muscle cell multiplication (a process called hyperplasia) as well as tighter skin and thicker hair. Not everyone knows, however, that a HGH cycle is always used along with a strong anabolic like testosterone. You see, testosterone and other strong anabolics work their magic by increasing muscle cell size (a process called hypertrophy) as well as strengthening our nerves and rewiring our body for ultimate strength. Remember, HGH increases result in hyperplasia, the creation of new muscle, while hypertrophy makes that newly created muscle cell larger and larger. So what's the use of taking an anabolic without taking something an Human Growth Hormone releaser that consistently raises HGH levels to supraphysiological levels? As any advanced supplement user would tell you, it's essential to take these two things together in order to get the most out of every precious moment in the gym. Natural Testosterone Booster – Step 4 There comes a point in any cycle where your body begins to get smart to what you're doing with these extra muscle building compounds – the prohormones, the steroids or the legal steroids. It begins to think- with all this additional testosterone and other hormones, that it no longer needs to produce these compounds. Your own endogenous levels (meaning 'from within') begin to go lower and lower which defeats your purpose of supplementation in the first place.. After all, you don't want use of one powerful product to cause the loss of your own body's ability to create those hormones itself. You want to turbocharge your muscle making machinery, not stunt it, right? That's where natural Testosterone boosters come in. With a precise blend of cutting edge ingredients, Natural Testosterone Boosters like Tribulus Terrestris ensure that your body will continue to work WITH you rather than against. A scientifically proven ratio of biopharmakinetic compounds can keep your own body's testosterone levels in check. You’ll get the benefits of the other steps without the rebound effect of testosterone production shutdown that sometimes happens with the use of a prohormone or steroid. Anti-Estrogen, Aromatase Inhibitor – Step 5 Whether you are in the middle of an anabolic cycle or whether you are just coming to the end of 8 weeks of focus and effort, you will undoubtedly need a product that can keep your estrogen levels in check. Here's why. Did you know that estrogen is responsible for most of our fat storage? Excess levels of estrogen have been shown to increase fat storage at an unbelievable rate, especially in the presence of extra calories. Normally, you consume larger amounts of calories during your cycle. You want to make sure each pound of food you eat goes directly to muscle. Too much Estrogen and you risk food turning into fat or even worse, Gynecomastia, or enlargement of the breast. An anti-estrogen keeps your Estrogen levels low during your cycle so that all your gains will be in hard and ripped muscle rather than soft and flabby adipose tissue (otherwise known as fat). TO KEEP YOUR GAINS AFTER YOU EARN THEM If you've ever run an anabolic cycle in the past then you know all too well it's just as important what you do AFTER a cycle as it is what you do DURING a cycle. As soon as you stop taking a powerful anabolic, your body will need to recuperate. Estrogen levels could skyrocket and worse yet, testosterone levels could drop. With an anti-estrogen, aromatse inhibitor your body will begin to recover from your cycle the moment you end, blocking estrogen conversion and protecting your testosterone levels and natural production. Do look for products that are specifically created to work together synergistically. All of ours are designed to complement each other so that their effect is magnified substantially when you use them together. It’s a way of getting more muscle “bang” for your buck. 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Since the introduction of Rogaine in the early 1980's, androgenic mediated hair loss, or 'male pattern baldness' has been considered a treatable condition through the use of pharmaceutical preparations. The perception that over-the-counter and prescription drugs are the only means to successfully treat this type of hair loss is perpetuated by the lack of well-funded and publicized studies on the efficacy of natural treatments. However, as the understanding of the biological mechanism of male pattern baldness has become clear through a great body of research, the reality of an effective natural treatment regimen is at hand. After a review of the available natural products, some suggestions will be made for creating your own regimen for treating hair loss naturally. The overall cause of male pattern baldness is now well-known: this type of hair loss seen in about a third of the male population is mediated by the androgenic metabolite of testosterone known as dihydrotestosterone or DHT. The production of this now-infamous hormone increases later in life for many men, along with changes with the receptors for this hormone at the hair follicles. In general, the pertinent hair follicles shrink with continued exposure to the androgenic hormone, some forming only small, villus hairs, while others eventually die completely. Some sources claim these follicles are still getting an adequate blood supply, while others note a waxy buildup or scar-like tissue surrounding the follicles, preventing adequate nutrient delivery. Thus, the localized cause of hair loss, at the follicle level, is still being researched. This does not mean there has been success in discovery of natural hair loss remedies! The regrowth of hair due to androgenic-induced loss should be addressed on two fronts. First, the levels of DHT produced within the body (rather than topically) should be addressed, along with the binding of DHT at it's receptor sites. Second, hair growth should be stimulated topically with application of nutrients and/or DHT suppressors on the follicles themselves. Let's first address the suppression of DHT production and binding systemically (within the body). Prescription drugs such as Finasteride and Dutasteride are available which lower blood levels of DHT, and have been used to improve hair loss conditions. There are now several well-known natural, plant-based products which either reduce testosterone's conversion to DHT (via the 5-alpha-reductase enzyme system), block the binding of DHT to receptor sites, or both. Most common, and most important are Saw Palmetto Berry extract and Stinging Nettle Root extract. These to herbs work in combination to both block the conversion of testosterone to DHT and prevent it's binding to receptor sites in the scalp. Other herbs employed with similar functions include pygeum africanum and pumpkin seed oil, both used to bring into balance the testosterone/DHT ratio; lastly, the plant sterol Beta-Sitosterol is often used successfully to treat prostate enlargement, which has similar causes to male pattern baldness - whether it will support hair growth is not yet known, but it likely won't hurt!. Finally, getting an adequate supply of Zinc is also important in maintaining this hormonal balance. The entire androgen hormone regulation system is fairly complex; just remember these items: Saw Palmetto, Nettle Root (not leaf!), Pygeum, Zinc, and Beta-Sitosterol. By the way, if using a prostate formula for these nutrients, they should be taken in gel cap form - they are better absorbed this way than in plain powder, and hence more effective. In addition to these herbs, which are also commonly used around the world for blocking the creation and effects of DHT, Procyanidins, or Polyphenols, have been shown to inhibit DHT systemically, AND can stimulate hair growth when applied topically. These anti-oxidant compounds first became renown with the discovery of the amazing action of grape seed extract and it's powerful ability as a free-radical scavenger. More recently, Japanese researchers went through the effort of testing HUNDREDS of compounds in the laboratory for their effect on the stimulation of hair growth, and they found the compounds of grape seed extract grew hair at a greater rate than the pharmaceutical preparation Minixodil. With further testing, using variations of the polyphenols, they discovered those found in apple skin polyphenols to be even more effective, nearly twice effective as Rogaine. Further, with the addition of Forskolin, another herbal extract, the effect was even greater. Exciting news! The interesting thing is that these compounds actually stimulated the hair follicles to become active, whereas it seems Rogaine works by lowering blood pressure in the scalp, thereby increasing blood flow to the follicles. And these compounds did not produce an initial 'shedding' as Rogaine has been known to do. Ok, before we get to the good stuff - like how to create your own hair regrowth program, let's look at one more class of natural products - essential oils. Essential oils are powerful, aromatic compounds distilled from plants, with highly regarded medicinal properties, well beyond the effects of only their aromas. Rosemary essential oil has long been considered a 'hair tonic', more than likely because of it's ability to stimulate blood flow locally. A certain type of rosemary, known as rosemary verbenone, also contains compounds which influence skin regeneration. Recall the addition of Retin-A to the use of Rogaine? This was to stimulate the turnover of the skin, increasing the pace of the hair regrowth process. Other essential oils, such as Lavender, have an anti-inflammatory (inflammation is sometimes implicated in hair loss) and skin regenerating effects. Thyme and Cedarwood oils have also been studied, and the combination of these oils has been shown effective at hair growth stimulation in patients with alopecia areata. Given all this wonderful information, how does one combine them into an effective regimen? The best thing to do is keep it simple - the more simple it is, the more likely it is you'll stay with it for the several months it will take to see significant effects. So, for the systemic DHT suppression and inhibition, look at formulas either designed specifically for hair, or those for the support of the Prostate gland - they will contain almost the exact same ingredients. Look for a high-quality supplement, with standardized Saw Palmetto extract, Nettle Root extract, and Pygeum extract. Do not take the un-extracted herbs, they will not likely be strong enough in doses you are willing to consume. Saw Palmetto can be consumed in doses between 160 and 320mg daily, Nettle Root a bit more, and Pygeum significantly less. They should be in a gel cap, preferably in Pumpkin seed oil. Take a separate Beta Sitosterol supplement, around 400mg daily, if it is not included already. This is typically found in dry capsules, and there have not been reports of the importance of consuming this in an oil-based capsule, though you can take it with fatty food if you want to be sure (this may help the absorption). Add an oral supplement of Green Tea extract, Grape Seed extract, or Apple Polyphenol extract if you like, along with a good multivitamin. Now for the topical applications - the polyphenols can be mixed in water. Even better would be to find Nettle Root, grind it up and make a strong tea. To this, create a 1-3% solution by weight of the polyphenols in the liquid and apply twice daily (shake really well or use a blender). Grape seed extract is acceptable, though apple polyphenols would be best. They are hard to come by just yet, but are becoming more popular and available. A bulk supply is best, so you don't have to go opening capsules! A .5-1% addition of Forskolin herb extract can be made io increase effectiveness, but is not completely necessary. Applying right after a shower may make it easier to distribute the liquid on the scalp, and may also increase absorption. It is important to note that increasing the concentration beyond 1% for Grapeseed extract and 3% for Apple polyphenols extract is not advised - higher concentrations did not show increased efficacy - in fact, there may be an opposite effect. For the record, there are about 30 grams of water in one ounce; 1 gram of powder in this is just over a 3% solution. Finally, to this solution, a small amount of the Saw Palmetto blend from a ge lcap can be added - though the efficacy of this has not been noted in the literature. For the essential oils, use 1ml of each oil per one once of carrier oil (a blend of jojoba and grapeseed was used in the study showing hair regrowth in Scottland). Because this is isn't as attractive once applied, though you will smell nice, apply in the evening, before bed, between once a day and once every three days. Or apply during the day some time, massaging into the scalp, and leaving in for 20 minutes to an hour, then wash out. This will give enough time for the oils to penetrate the skin and have their effect. So there it is, the roundup of the more well-known and tested natural remedies for male pattern baldness. While Rogaine for growth stimulation, and Finasteride or Dutasteride for DHT inhibition are completely reasonable ways to go, their costs are high and the effects of their long term use are not well known. And then there are some folks that would prefer to stay away from chemically manufactured medicines altogether - hopefully this bit of information will help. There is much more research available on the internet, though hopefully this is enough information to get you confidently started. vimax penis pillss in uk free pennis enlargement video penis enlargement secret herbal pnis enlargement penis enlarement operation do penis enlarement pills really work real penis enlargment herbal natural pennis enlargement penis enlarement patch
Given the large variations in human penis sizes, discord and dissatisfaction with one's self are unavoidable. The longest erect penis recorded during the famous Kinsey surveys was a shocking ten inches. That is nothing compared to the 12" and 14" behemoths reported in "L'Ethnologie du Sens Genitale", and in Dr. David Reuben's "Everything You Always Wanted to Know About Sex", respectively. If that makes you want to cry, wait till you hear the good news - the shortest functioning erect penis measurement according to the Kinsey survey was 1 inch. There are, however, some reports in medical literature of penises that do not extend beyond 1 cm. when fully erect. Finally, just so you can know which side of the fence you are hanging from, a study by the Lifestyles Condom Co. indicated that the average erect length of a male sex organ is 5.877 inches. Women have often been reassuring towards their mates in this regard. "Size doesn't matter", they would say. Few men really believe that. In an online poll that asked if respondents felt that penis size makes a difference in a man's ability to sexually satisfy a partner, 46% of the respondents answered "Very much: Penis size makes a big difference in a man's ability to sexually satisfy a partner". Only 13% responded "Not at all: Penis size makes no difference in a man's ability to sexually satisfy a partner". The poll did not mention how many of the respondents were women and how many were men, but the fact is - men and women believe that size still does matter! In "The Beefcaking of America," (Psychology Today November/December 1994 issue) Jill Neimark reported the findings from a questionnaire completed by some 1500 male and female readers. The Neimark report suggests that a significant subset of women who are financially independent and rate themselves as physically attractive place a high value on male appearance. A small group unabashedly declared not only an rather unsurprising strong preference for better-looking men, they also indicated that they cared more about penis size, both width and length, than about the physical appearance of the man. Niemark's survey results also suggests that men believe their appearance has a larger impact on women than the majority of women actually acknowledge. Men indicated they feel their specific physical features, from hairline to penis size, strongly influence their personal acceptability by women. "Size does matter". Judging by the number of sites Google.com returns on a search for "penis enlargement", that seems to be a pretty popular opinion. As long as there are men out there running around with 14" monsters, the rest of the mortals will continue to judge themselves and pray at the altar of everything that grants bigger penises. The results of penis enlargement are not always pretty, considering the various methods that are purportedly effective. Claims range from the scientific to the outrageous, and some of them can be downright nasty. Unlike lizards, men do not have the power to regenerate lost appendages, so it is highly advisable to do a little research before fooling around with Mother Nature's precious gifts. The following is a list of some penis enlargement methods other than penis pills, followed by some general comments about each; Enlargement creams do nothing more than increase blood flow in the penis tissue. While this may definitely assist in erection firmness (Which will cause the penis to appear and feel larger), using creams cannot enlarge your penis. There is no known medical evidence too support the claim that topical preparations can do more than increase blood flow, unlike penis pills. Penis pumps create a vacuum and force blood to the penis tissue. According to Menstuff® Sexhealth columnist Dr. Williams, pumps are mainly used by men who suffer from chronic insulin dependent diabetes or circulatory disorders. They have such poor blood circulation overall that they cannot obtain proper blood flow in their penis area. By using a pump instead of penis pills, the skin and underlying tissues are stretched, allowing them to clamp off the blood flow and consequently trap it in the penis. With the clamp firmly in place, brief sexual encounters can occur. There is little medical evidence that penis pumps cause any actual permanent increase in the size of the penis. There is, however, bad news for "pumpers" out there - after using penis pumps over a period of time, some men claimed they were unable to get erections without the aid of a pump. This method of penis enlargement has been around for thousands of years. Weights are suspended from the penis to stretch it. With regular use, it can increase penis length - but at a price: It makes the penis thinner, and because of the stretched tissue, lessens the ability to achieve and maintain an erection. This method can also cause a decrease in blood circulation which can lead to serious problems including tissue damage. Penis enlargement surgery (or phalloplasty) is the Titanic of penis enlargement methods. It is huge, expensive and can end up being the worst disaster of your life. It can lead to serious complications like infection and scar tissue formation which can cause a misshapen penis. A well known horror story is that of Ron Nance, from Monterey, Calif., who claims that following his penis enlargement surgery he contracted a severe infection at the surgery site. He returned to his doctor, who re-sutured the incision. The complications persisted, and Nance claims he flew to Los Angeles a total of nine times for repairs before turning to other surgeons for help. Nearly two years later, with $20,000 invested in the operation and repairs, Nance states that he remains not only permanently scarred, but impotent. Other enlargement surgery patients have complained of disfigurement, shortening, loss of use of his penis, pain, swelling, excessive scarring, lumpiness, shrinkage, uneven surface with what appears to be cysts, and impotence. Many penis pills are nothing more than vitamin pills in disguise, and numerous men have been conned into popping them expecting more than what vitamins can deliver. Penis pill salesmen Michael A. Consoli, Vincent J. Passafiume, and several others have signed a consent agreement forfeiting approximately $35 million dollars in seized cash and property to settle charges that they had marketed penis enlargement pills with false claims. Operating as C.P. Direct, Inc., they claimed that their enlargement pill product "Longitude" would permanently enlarge the penis by 1-3 inches. They are not alone. So what penis enlargement supplements do work? The problem in discovering this lies in the fact that there are approximately 5 new "amazing" penis enlargement pills that appear on the market each month. Most of these products are nothing but Vitamins mixed with a few herbal ingredients to produce a penis pill. Users see NO gains, and this leads to unhappiness and loss of faith in all enlargement supplements. As with most things, the way to do properly choose a product is through systematic research. This will definitely take some time and effort, however if you obtain the results you desire, in the end it will definitely be worth your while. Some things to keep in mind: Stay away from any pill which contains Yohimbe. The FDA has placed this substance on its warning list - supplements containing this herb may cause side effects. A respectable supplement site will contain a list of the ingredients that their products contain. 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What could possibly be worse than struggling with a painful condition and feeling ashamed to discuss the problem because of its intimate nature? Such is the case for many suffering with pudendal neuralgia, a little known disease that affects one of the most sensitive areas of the body. This area is innervated by the pudendal nerve, named after the Latin word for shame. Due to the location of the discomfort combined with inadequate knowledge, some physicians make reference to the pain as psychological. But nothing could be further from the truth. Unfortunately, discussing the condition with gynecologists, urologists and neurologists often proves fruitless since most know nothing about the condition and therefore cannot diagnose it. Pudendal neuralgia is a chronic and painful condition that occurs in both men and women, although studies reveal that about two-thirds of those with the disease are women. The primary symptom is pain in the genitals or the anal-rectal area and the immense discomfort is usually worse when sitting. The pain tends to move around in the pelvic area and can occur on one or both sides of the body. Sufferers describe the pain as burning, knife-like or aching, stabbing, pinching, twisting and even numbness. These symptoms are usually accompanied by urinary problems, bowel problems and sexual dysfunction. Because the pudendal nerve is responsible for sexual pleasure and is one of the primary nerves related to orgasm, sexual activity is extremely painful, if not impossible for many pudendalites. When this nerve becomes damaged, irritated, or entrapped, and pudendal neuralgia sets in, life loses most of its pleasure. So, where exactly is the pudendal nerve? It lies deep in the pelvis and follows a path that comes from the sacral area and later separates into three branches, one going to the anal-rectal area, one to the perineum, and one to the penis or clitoris. Since there are slight anatomic variations with each person, a patient’s symptoms can depend on which of the branches are affected, although often all three branches are involved. The fact that the pudendal nerve carries sensory, motor, and autonomic signals adds to the variety of symptoms that can be exhibited. Because pudendal neuralgia is uncommon and can be similar to other diseases, it is often misdiagnosed, leading some to have inappropriate and unnecessary surgery. Early in the diagnosis process, it is crucially important to undergo an MRI of the lumbar-sacral and pelvic regions to determine that no tumors or cysts are pressing on the nerve. In addition, the patient should be screened for possible infections or immune diseases, as well as having an evaluation by a pelvic floor physical therapist to determine the health of the pelvic floor muscles and to uncover whether skeletal alignment abnormalities exist. An accurate patient history is needed to assess whether there has been a trauma or an injury to the nerve from surgery, childbirth, or exercise. Tests that offer additional diagnostic clues include sensory testing, the pudendal nerve motor latency test, and electromyography. A nerve block that provides several hours of relief is another tool that helps to determine if the pudendal nerve is the source of pain. One of the most common symptoms that accompanies pudendal neuralgia is severe depression. Some people with the disease have committed suicide due to the intractable pain. For that reason, it is important to consider antidepressants, as they can help lessen the hypersensitivity of the genital area in addition to relieving bladder problems. Certain anti-seizure drugs reportedly help to alleviate neuropathic pain while anti-anxiety drugs provide substantial relief of muscle spasms and assist with sleeping. Uninformed physicians are reluctant to prescribe opiates for an illness that shows no visible abnormality, yet the desperate nature of genital nerve pain requires that opiates be prescribed for these patients. While medications are not always satisfactory, they do help take the edge off of the pain for many people. Until the correct treatment is determined, it is imperative that patients with pudendal neuralgia receive adequate pain management since the pain associated with this illness can be intense. Treatment depends on the cause of distress to the nerve. When the cause is not obvious patients are advised to try the least invasive and least risky therapies initially. Physical therapy that includes myofascial release and trigger point therapy internally through the vagina or rectum assists with relaxing of the pelvic floor, especially if pelvic floor dysfunction is the cause of nerve irritation. If no improvement is found after six to twelve sessions, nerve damage or nerve entrapment might be considered.Botox is now used in medical settings to relax muscles and shows promise when injected into pelvic floor muscles; though finding a physician adept at this treatment is difficult.Pudendal nerve blocks using a long-acting analgesic and a steroid can reduce the nerve inflammation and are usually given in a series of three injections four to six weeks apart. If physical therapy, Botox, and nerve injections fail to provide adequate relief, some patients opt for pudendal nerve decompression surgery. There are three published approaches to pudendal nerve decompression surgery but there is debate among members of the pudendal nerve entrapment community as to which approach is the best. Since there are advantages and disadvantages to each approach, patients face considerable confusion when deciding which type of surgery to choose. Because there are only a handful of surgeons in the world who perform these surgeries, most patients have to travel long distances for help. Moreover, the recovery period is often painful and takes anywhere from six months to several years since nerves heal very slowly. Unfortunately, early statistics indicate that only 60 to 80 percent of surgeries are successful in offering at least a 50 percent improvement. Patients whose surgeries are not successful or who do not wish to pursue surgery have the option of trying an intrathecal pain pump which delivers pain medication locally and helps to avoid some of the side effects of oral medications. Others pursue the option of a neurostimulator either to the sacral area or directly to the pudendal nerves. These are relatively new therapies for pudendal neuralgia so it is difficult to predict success rates. Some pudendalites have devised ingenious contraptions for pain relief ranging from u-shaped cushions cut from garden pads all the way to balloons filled with water, frozen, and inserted into the vagina. Most have a favorite cushion for sitting and many have special computer set-ups for home and office use in order to avoid sitting. Generally speaking, jeans are a no-no, so patients revise their wardrobes to include baggy pants and baggy underwear – if they are able to tolerate wearing underwear. Clearly more research is required to find effective methods to better manage the pain and debilitation of pudendal neuralgia. But in the meantime, friends and family close to those who have this devastating illness play a huge role in helping patients cope, thereby maintaining the best quality of life possible. Support, love and understanding are of primary importance for those suffering with this affliction.