Dear Yvonne,
How important is foreplay for women? Is it something that’s overblown because women, like my lady, want more attention from their guy?
-Unsigned

Dear Unsigned,
How important is foreplay? How high is the sky!?  Foreplay is VERY important for both sexes, but often emphasized among women due to the physiological fact that orgasmic response tends to function on a slower course for gals than guys. Plus, given that the brain is our most powerful sex organ, using a blend of flirtation and suggestion to prep a lady makes an excellent foundation for one’s foreplay efforts. Women can help their partners by thinking sexy thoughts in advance of sensual liaisons to “warm the engine,” especially in instances where heated, lusty quickie sex is indicated. A woman whose body and mind have not been adequately prepped for penetration and release can wind up dry, sore both inside and out, bitter and resentful. 

Honoring a female’s sexual response is vital to a healthy and fulfilling sex life!  That said, there are times when women can go 0-60 in seconds from some titillating material (read: high octane foreplay). This will vary greatly from woman to woman, just as with men, and is worth taking the time to communicate about fantasy and hot topics so you will have adequate tools in your arsenal to turn her on. Lastly, don’t forget to communicate effectively to understand what feels good, what sounds good, and what tastes good to your lady friend, as this will go a long way to a satisfied coupling and your success in the sac.

Dr. Yvonne Kristín Fulbright is a sex educator, relationship expert, columnist and founder of Sexuality Source Inc. She is the author of several books including, “Touch Me There! A Hands-On Guide to Your Orgasmic Hot Spots.”

Sometimes, making a mistake teaches an invaluable lesson.  And so it is with the loophole in Nebraska’s “safe haven” law, a statute that allows parents to drop off children at hospital emergency rooms if they are unable to care for them.  The trouble is, Nebraska lawmakers neglected to define “child.”  So far, 34 children, some of them as old as 17, have been dropped off, including two teenagers just last Thursday. 

A special legislative session is underway in Nebraska to fix the law.  While different bills have been offered, the legislature will probably end up defining a “child” as one year of age or under.

Fixing the safe haven law, however, won’t fix the problem that the mistake in Nebraska has uncovered.  Many parents there—and across the nation—feel utterly unable to parent effectively and are looking for a way out.

It would be easy to demonize parents who bring a 5 or 13 or 17-year-old son or daughter to the hospital and say goodbye, but I don’t presume that all or most of these parents are unfeeling monsters looking to shirk responsibility and lay it at the doorstep of government.  And even for the percentage of parents who are that disordered in their characters, I wouldn’t want their children to remain in their custody, anyhow.

The real problem isn’t the Nebraska loophole, it’s the lack of available guidance and services for parents who are dealing with children and adolescents more prone than ever to use alcohol and illicit drugs, fall victim to psychiatric disorders like Attention Deficit Disorder and Bipolar Disorder and even succumb to joining gangs (which are now invading the suburbs, not just confined to urban centers).   The story of a Florida man driving all the way to Nebraska to drop off his 11-year-old boy is a story of desperation, not depravity.

I’ve always believed that we end up paying exponentially, in the long run, for underestimating how many American families are in crisis, without parents who can properly direct, discipline and nurture their kids.  Now, we have a little window, thanks to Nebraska, on the intensity of the trouble in some families, though still no insight into the real number of such families.

What is called for is a system of graduated aid to families in psychological distress.  This has to begin with case finding—perhaps through the schools—and continue through a spectrum of services, including parenting courses, child counseling and medication clinics, respite services and, yes, beefed up options for good foster care and adoption.

Here’s something to think about:  I recently referred a Massachusetts girl to a local child psychiatrist for help with symptoms that were overwhelming her parents and her school system.  Until she used my name to move up on the waiting list, she was given an appointment four months down the road.  And that’s Massachusetts, comparatively rich in medical resources.  According to Time magazine, Nebraska has a grand total of six child psychiatrists in the entire state.

So many in Congress are all about bailing out the auto industry and the banking industry and the mortgage industry and maybe a few cities along the way, moves that will ultimately weaken the marrow of our economy, upon which rests the hope for renewed ideas and approaches to real economic growth.  Some of their energy would be better spent bailing out emotionally overwhelmed American families, upon whose children’s shoulders rests the future.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com or e-mail him at info@keithablow.com.

A recent survey of 12,000 general practice physicians found that 60 percent of them feel they’re overworked, are planning on quitting or cutting back their hours, and that they would not recommend medicine as a career.

I get it — I too feel tired and overworked — but I would not go as far as to say that I don’t recommend medicine as a career. Medicine, to me, is an art. I just wish I could practice it with less bureaucracy. One of the most common complaints I get from physicians, nurses and general medical personnel, is the tremendous amount of paperwork that is required in today’s heavily regulated industry. Many people would argue that physicians brought this upon themselves, that all this regulation was necessary to make sure safety standards grew and that patients’ bill of rights were protected.

So I asked some of my friends in the healthcare field: “Would President-elect Obama bring good news for our healthcare system?” And the most frequent answer I got was, “We don’t know.”

I believe some of my peers feel that there are so many priorities for our new government, healthcare may take a backseat.

So then I asked them, “How would you advise our new president-elect with regard to some of the doctor dissatisfaction survey results?”

Here’s a compilation of their wish list:

1. Malpractice reform

2. Significantly reduce the cost of medical education

3. Educate the consumer to create realistic expectations on what the healthcare system can provide

4. Decrease bureaucracy

Let’s face it, there are many choices President-elect Obama can make. But unfortunately, with the state of the economy being a top priority, his resources are limited and his agenda is yet to be seen. So I guess as physicians, we just have to continue to create innovative ways to save the American healthcare system. But one thing is for sure — I still dream of my little girl being a doctor one day.

A few years ago, with my LDL cholesterol pushing 125, I decided to start myself on Lipitor with the approval of my own internist. Despite the fact that my father has heart disease, I knew that I was in the category of patients where there were no clearcut guidelines. In fact I knew at the time that most cardiologists would probably say that I was jumping the gun and erring on the side of overtreating. But the latest research would suggest that I was probably right.

As most of my readers know by now, a new landmark study just published in the New England Journal of Medicine, Known as JUPITER, looked at more than 17,000 healthy men and women at multiple centers in the U.S. and Europe with normal cholesterols (LDL less than 130 mg/dl) but with elevated C-Reactive Protein levels. Many scientists believe that high levels of this protein correlates with a high risk of heart disease, though there is by no means a consensus on this.

Previous studies who shown that patients with multiple cardiac risk factors have less heart attacks and strokes when taking a statin drug, but this is the FIRST large study in people with relatively normal cholesterol where taking a statin dramatically affected outcome.

The JUPITER trial was stopped after 2 years because the results were so dramatic – there were half as many heart attacks and almost half as many strokes and unstable angina in the group which received Rosuvastatin (Crestor). I’m sure that these results will lead more doctors to prescribe more statin drugs, expecially Crestor. But the real question is, who should receive the drug and who shouldn’t? Detractors of the study will point out that Astra Zeneca, which makes Crestor, was a sponsor of the study and that it was only two years long. But this doesn’t take away from the dramatic results.

Patients and their doctors who have previously been very conscious of muscle aches that they ascribe to the drug, or are now aware of the possible slight increase risk of diabetes that the study detected, will still have to consider the fact that Crestor and likely other statin drugs appear to dramatically decrease cardiac risk. Here is my take:

*  I will have a much lower threshold for prescribing statin drugs, especially in patients older than 50. (the study looked at men in their 50s and women in their 60s).
*  I will be more inclined to prescribe statins for primary prevention (patients who have no known heart disease) on the basis of cardiac risk factors (family history, smoking, high blood pressure, etc) even when their cholesterol is only mildly elevated (LDL cholesterol between 110 and 130).
*  I will follow CRP levels in patients over 50 years old, especially in those with cardiac risk factors, but I continue to reserve judgment on the specific significance of these results.
*  I will continue to emphasize diet modification, stress reduction, and increased exercise as mainstays of primary prevention of heart disease.
*  I will be glad to see further longer studies on statins, though I recognize the importance of JUPITER.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com

Eating fruit is one of the best ways to increase your fiber intake while still satisfying your sweet tooth.  Fruits are a great source of antioxidants, fiber, and vitamins.  They are highly beneficial when incorporated into your diet on a daily basis.  They are low in caloric density, so they fill you up on few calories.
While fruit might seem better to binge on then a box of cookies, it is hard to gauge how much you are eating without measuring an actual portion. To avoid overconsumption, measure out the amount you plan to eat and stick to that. According to a study conducted by the ADA, many people think eating after a meal leads to excess calories, which eventually leads to weight gain. Actually, it’s not when in the day you eat that matters, it’s what and how much you eat. At the end of the day, it is calories that control weight gain or weight loss. Even the healthiest foods, when eaten in greater amounts than needed for energy will be stored as fat.

Fiber is the indigestible part of plant foods. It cannot be broken down or digested, therefore it add no calories to your diet—allowing you to fill up without filling out. While all fruits contain some fiber, some pack a bigger punch than others. Fruits you eat with the skin on, like apples and pears, tend to have more fiber than fruits that you peel (oranges and bananas). Fruits with seeds are filled with fiber, which makes raspberries, strawberries, blueberries, figs, and blackberries all great choices. While dried fruit is a good source of fiber, be careful with the quantity since they pack a lot of calories and are sometimes sold in sugar-added varieties. Canned fruits have the least amount of fiber since they are stripped and processed, so stick with fresh fruit whenever possible.
 
 Here is a list of fruits for you to enjoy!

Tanya Zuckerbrot, MS, RD is a nutritionist and the creator of The F-Factor Diet™, an innovative nutritional program she has used for more than ten years to provide hundreds of her clients with all the tools they need to achieve easy weight loss and maintenance, improved health and well-being.  For more information log onto www.FFactorDiet.com. 

Dear Yvonne,
My girlfriend and I have had sex a few times and it seems every time we do it missionary-style, the condom breaks. Is this common or is there some way to prevent this? Any help would be greatly appreciated.
-Marshall

Dear Marshall,
Condoms can break for any of the following reasons: They’re not being used correctly; they were manufactured improperly, they’re past their expiration date or were damaged after manufacture. In most cases, breakage is due to human error, especially incorrect use, like not leaving a half-inch of space to collect semen at the tip or unrolling a condom the wrong way. Given this is a regular occurrence, it’s likely that your condom breakage woes have more to do with the way this prophylactic is being put on versus any manufacturing problem. 

To correctly put a condom on, do the following after checking the expiration date:
1.   Make sure the condom is right side out.

2.   Pinch an inch at the tip, especially if you’re not using a reservoir-tip condom, so that the semen can be collected.

3.  If you’re uncircumcised, pull back the foreskin before unrolling the condom on.

4.  Smooth the condom over your shaft to get rid of any air bubbles that can cause your condom to break.

Dr. Yvonne Kristín Fulbright is a sex educator, relationship expert, columnist and founder of Sexuality Source Inc. She is the author of several books including, “Touch Me There! A Hands-On Guide to Your Orgasmic Hot Spots.”

The other day I was asked if I expected an increase in the number of babies that I will be delivering in 2009 and I said “Absolutely, I expect an Obama baby boom.”

Now this is a topic that I know a lot about. Pregnancies come in cycles. I mean let’s face it, some pregnancies are accidental, some pregnancies are planned. But the trend has always been that life-changing events tend to bring people together. And you know what happens when we bring people together―nine months later, we have a blessed child.

I don’t know what it is about these life-changing events―maybe fear or euphoria is the most attractive indicator―but nonetheless, as someone who runs a hospital that delivers more than 6,000 babies a year, I have a pretty good idea when we can expect our birth rates to go up.

Now let’s talk about those life-changing events. Politics in and of itself does not make a very sexy scenario to plan a pregnancy. But I can go as far back as 1961 with the election of John F. Kennedy to tell you that following his election cycle, we saw an increase in births. The last four Republican presidents have also seen a spike in the birth rate during their presidencies. So if the trend continues, I do expect president-elect Obama to give us a significant increase in the national birth rate.

However, I think that this Obama baby boom might be more significant than others. The reason? There are two key factors president-elect Obama is bringing to the table that we have not seen on a national level in many years. Number one: Obama has such a positive optimism in some of the changes he has offered, which have resonated in the psyche of many Americans. And two: One of the top priorities on president-elect Obama’s agenda that he would like to try to accomplish in the early phases of his presidency is healthcare reform.

So I hope that president-elect Obama sets his sights on women’s healthcare with a focus on giving women the access to prenatal care that they truly deserve. Yes, this is going to be “change that you can believe in.”

Police in St. Johns, Ariz., allege that an 8-year-old boy gunned down his father, Vincent Romero, and his father’s co-worker, Timothy Romans, using a .22-calibre rifle.  They say the crime was planned and methodically carried out.  Prosecutors have not yet announced whether they will seek to try the 8-year-old as an adult.

First things first:  Without access to the information that police have at this time, the public should withhold judgment about the veracity of the 8-year-old boy’s confession. False confessions are common enough in traumatized, eager-to-comply adults, let alone kids.  Three other children between the ages of 7 and 8 have confessed to murder since 1958; none of them committed the killings.

Assuming that the boy in Arizona is indeed the perpetrator, mental health professionals will have the task of trying to ascertain why he committed two murders.  Already, neighbors and friends and school officials have commented that the boy seemed perfectly normal, seemed to have a good relationship with his dad and had no history of violence.

As a forensic psychiatrist I have evaluated many killers and testified about them in court, not to mention treating dozens of very violent people.  And I promise you that, if responsible for these murders, there is indeed a psychological explanation why the boy committed them. 

Possible explanations include the boy suffering an underlying mental illness causing a delusion (a fixed and false psychotic belief) or hallucinations.  Conditions like bipolar disorder, for example, can (in a great minority of cases) trigger paranoia and even voices commanding one to carry out actions that would normally be abhorrent to the afflicted individual.   No one has suggested that Romero’s son suffered such a condition, but clinicians will need to rule out the possibility.

If the boy has been under treatment for any psychiatric symptoms with medications, the possibility of a medication side effect has to be explored.  Some psychoactive medications can, in rare cases, prompt violence against oneself or others.  The same is true, by the way, for some medicines used to treat medical conditions, like asthma.

Even in an 8-year-old, the remote chance that a mind-altering substance could be involved — perhaps belonging to someone else who was present at his school or in his home — has to be excluded.  That should be relatively easy to do by taking a detailed history from the boy and testing his blood and urine. 

Neurological explanations have to be entertained.  An MRI or CT scan of the alleged killer’s brain can tell investigators whether or not pathology like a brain tumor could be responsible.  The possibility is small, but can’t be dismissed out of hand.  Even an infection of the 8-year-old’s cerebrospinal fluid — the fluid that bathes the spinal cord and the brain—has to be formally eliminated as a possibility.

Chances are, however, that the why for these killings would reside in the emotional pathology of the alleged killer, not his brain pathology.  Some trauma or series of traumas, near or far in time, has to have occurred, in order to make this child either desperate enough to kill or cold-blooded enough to kill.  In sixteen years practicing psychiatry, I have never met a murderer who was born evil.  In every case, I eventually learned the circumstances that extinguished that person’s empathy.

So if this 8-year-old boy is indeed a murderer, the search will be for the roots of his violence.  We have only a hint which questions to ask from the news coverage to date.  But here are a few:  Why was the boy’s father awarded sole custody of him?  Why is his mother residing in Mississippi, rather than closer to him?  What are the details of the boy’s living arrangement, including the fact that his father had rented out a room in the house to his co-worker?

The truth of this 8-year-old and his alleged violence is knowable.  The key to finding it is in asking enough questions and never buying into the myth that killers are born.  They are made.  And when one is made by age 8, enough bad has happened in eight years to make the unthinkable actually occur.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com or e-mail him at info@keithablow.com.

Just yesterday I was traveling back from Seattle from the annual meeting of the American College of Allergy, Asthma and Immunology.  Quite a coincidence I, the “allergist,” was seated next to a young woman who was recently hospitalized and admitted to the ICU for severe anaphylaxis to peanuts.

It was very relevant and timely, as the snack service provided by the airline included the serving of peanuts and peanut crackers to passengers.  My physician assistant and I immediately got involved and requested a “peanut-free zone” be extended around the food allergic passenger’s seat.  The flight attendants worked smoothly and professionally to make this happen and to avert a potentially serious health issue for the passenger who has a life threatening food allergy to peanut and nuts. 

Take home message: Don’t be afraid to speak up when traveling on a plane! Many airlines will likely try and accommodate you if they are aware of this type of condition.  It’s not a bad idea to alert the airline when you are making your reservation so the “on plane” staff is also aware of your allergies and can easily help assist you if peanut products are served aboard the aircraft. Some airlines have already moved to peanut free snack foods. Check with your airline to learn if they are peanut/nut free! For travelers with the severest allergies, it is best to bring food from home just to ensure freedom from allergy-causing ingredients.

Let’s review food allergy avoidance and management while away from home.

• First, if your provider has given you an epinephrine auto-injector (i.e. Twinject, Epi-Pen) make sure you have this medication with you at all times when traveling in case of anaphylaxis (food allergy and anaphylaxis plan should be in place). 
• Also remember to have a note from your provider indicating the need for you to carry the “auto-injector” on the plane. 

The Food Allergy and Anaphylaxis Network is a great resource for food allergy safety tips while traveling if you or a family member has a food allergy.  One strategy mentioned is to choose the first flight available in the morning. Airplanes are sometimes cleaned at the end of each day and flying early in the morning may decrease the chance that the seats will contain food crumbs or residue.

Go to http://www.foodallergy.org/Advocacy/airlines.html for more information. It’s important to remember that more than 3 million Americans have food allergies to peanuts and nuts.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

No matter how many studies suggest that testosterone, the hormone of sexual desire for both men and women, can help overcome a decreased libido, I will still be a fan of romantic dinners.  

Recent studies revealed that 25-50 percent of women have a low sex drive. I suspect that stress, dealing with diapers, lack of sleep and selfish mates have as much to do with this as an ebb in hormones. Nevertheless, in the wake of these findings, a new study, just published in the prestigious New England Journal of Medicine, has found an increased rate of “satisfying sexual episodes” in postmenopausal women who used a 300 mcg testosterone patch.

At a time when reproductive hormones are falling (post menopause), it is not surprising that a little testosterone goes a long way to rekindle the flame. But there is a clear cost. Testosterone can increase facial hair, muscular development, and even give you a lower voice. So, you may feel like having more sex, but you may look more like a man which could turn your partner off. Plus, there are the longer term risks to consider including potentially breast cancer, heart attack, or stroke.    

Testosterone patches are not approved for this use by the FDA, though they have been prescribed as sexual enhancers for women “off-label” for many years. An FDA advisory panel has considered them as recently as 2004, but rejected  them on the basis of safety issues. I’m sure that Proctor and Gamble, which manufactures the Intrinsa testosterone patch, and provided research grants for the current study, aptly named APHRODITE, will now expect the FDA to reconsider the issue, based on the study’s positive results. But safety is still an important issue. 4 of the study participants who received the patch as opposed to the placebo – were diagnosed with breast cancer. The long term risk of heart attack and stroke has still not been sufficiently studied, and remains a major concern.

I am not yet an advocate of these patches, though I know many other knowledgeable doctors who are, and have found them to be quite effective. For these doctors I would say that if romance isn’t the answer, that perhaps they are being reasonable to consider prescribing the patches on a case by case basis, even while I have my eye on the need for further research.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com