The condom is a barrier method of contracep- tion, which means that it establishes a physical barrier between contact of the penis and the woman’s vagina. This provides protection against STDs for both partners. Some men feel that using a condom somewhat dulls the sensitivity of the penis during sexual activity, and some partners feel that condoms inhibit spontaneity and diminish their experience of shared intimacy. However, couples can offset these perceptions by integrating the use of condoms into their sexual encounters so that it becomes part of the encounter rather than an interruption or interference.
Overall, the condom is about 85 percent effec- tive in preventing pregnancy; this rate takes into account condoms that are used incorrectly, are put on late (after there already has been vaginal con- tact), or break during intercourse. When used cor- rectly and in combination with a spermicide that the man can apply to the outside of the condom or the woman can place inside her vagina, a condom can be nearly as effective as the oral contraceptive. Vasectomy VASECTOMYis a procedure of surgi-
cal sterilization in which the physician cuts or lig- ates (ties off) the vas deferens (the tube that carries sperm from the testicle to the urethra during ejac- ulation). Vasectomy has no effect on LIBIDO (sex
drive), erectile function, ejaculatory volume or force, or sexual performance. Once a man has two negative sperm counts following the surgery, he is considered sterile—his ejaculate contains all the fluids it contained before the vasectomy but no sperm. Though there are operations to reverse vasectomy, their success rates vary. A man should have a vasectomy only if he is comfortable viewing the outcome as permanent.
Vasectomy is nearly 100 percent reliable. It is possible, though uncommon, for a vas deferens to spontaneously reconnect. Pregnancy following vasectomy is most likely when the man has unpro- tected sex before sperm counts verify that he is sterile; it is possible for sperm to remain in the ejaculate for four months and sometimes longer. Men who have vasectomies and their partners generally are satisfied with this method of contra- ception as it requires no preparation. However, vasectomy offers neither partner any protection against STDs.
Contraceptive Methods for Women
Numerous, and some of the most reliable, methods of contraception are available to women. The most effective are the hormonal methods that suppress ovulation, such as oral contraceptives (which must be taken daily) and time-release implants (which provide contraception for months to years depend- ing on the method), followed by the intrauterine device (IUD), which prevents a fertilized egg from implanting in the uterus. Barrier methods include the female condom (sometimes called an intravagi- nal sheath), and in a more limited context the diaphragm and cervical cap. Tubal ligation and hys- terectomy are permanent methods (sterilization).
See also CONCEPTION; FAMILY PLANNING; REPRO-
DUCTIVE SYSTEM; SEXUAL HEALTH.
coronary artery bypass graft (CABG) A surgical procedure to replace damaged and occluded coro- nary arteries (the arteries that supply the heart muscle with blood) as a treatment for CORONARY
ARTERY DISEASE(CAD). CABG is an open-heart sur-
gery in which the cardiovascular surgeon cuts through the sternum (breastbone) and exposes the heart. The surgeon then uses cannulas (large tubes) to reroute the flow of blood from the heart to a heart-lung bypass machine that takes over oxy- genating and pumping blood through the body for the duration of the operation. The surgeon stops the heart and uses segments of blood vessels har- vested from other locations in the body (such as the sapphenous vein in the leg or the mammary arter- ies in the chest), which are called grafts, to create new coronary arteries. These new arteries bypass the old ones to restore blood flow to the heart. Finally, the surgeon removes the cannulas and restarts the heart. The surgery itself takes from two to six hours, depending on how many coronary arteries the surgeon replaces. Recovery generally requires five to seven days in the hospital and six to eight weeks of home recuperation. Many men return to regular activities without limitations or restrictions once they heal from the surgery.
See also ANGIOPLASTY; HEART DISEASE; LIFESTYLE
AND HEALTH.
coronary artery disease (CAD) ATHEROSCLEROSIS
(accumulations of fatty deposits along the inner 100 coronary artery bypass graft
Crohn’s disease 101
walls of the arteries) affecting one or more of the coronary arteries that supply blood to the myocardium (heart muscle). CAD can cause symp- toms such as ANGINApectoris (chest pain that orig- inates in the heart) and shortness of breath, especially with physical exertion. CAD can lead to numerous heart problems, including ARRHYTHMIAS
(irregular heartbeat), cardiomyopathy (enlarged and weakened heart), and ischemic heart disease (temporary oxygen deprivation of a section of heart tissue), and is the primary cause of HEART
ATTACK (myocardial infarction). It is one of the
heart diseases known collectively as CORONARY
HEART DISEASE.
High blood levels of cholesterol and triglycerides
(HYPERCHOLESTEROLEMIAand HYPERLIPIDEMIA) increase
a man’s risk for CAD and also are indicators that some degree of CAD is present. Lifestyle factors such as diet and exercise can help reduce blood lipid levels and slow the progression of atheroscle- rosis and CAD. An angiogram, in which the cardi- ologist injects dye into the arteries to follow the flow of blood through the body and the heart, is the primary diagnostic procedure for CAD. Treat- ment is medical management of symptoms using medications and lifestyle modification when occlu- sions (blockages) are less than 70 percent; sur- gery—ANGIOPLASTY or CORONARY ARTERY BYPASS
GRAFT—becomes the treatment of choice when the
occlusion reaches 90 percent or when medications and lifestyle modifications can no longer manage symptoms.
See also CARDIOVASCULAR SYSTEM; CHOLESTEROL,
BLOOD; HEART DISEASE; LIFESTYLE AND HEALTH; NUTRI-
TION AND DIET.
coronary heart disease A term that collectively describes CORONARY ARTERY DISEASE(CAD), ischemic heart disease, and ANGINApectoris, three conditions
of heart disease that typically occur as a constella- tion and are integrally related to one another. Coro- nary heart disease is the leading cause of death among men and women in the United States.
See also HEART DISEASE.
corticosteroids The hormones the adrenal cor- tex produces (called endogenous corticosteroids) or medications that are chemically similar (called
exogenous corticosteroids). Endogenous corticos- teroids, notably cortisol and cortisone, are chemical messengers that have numerous functions related to metabolism. Doctors typically administer or pre- scribe exogenous corticosteroids to suppress the
IMMUNE SYSTEM as a means of managing systemic
inflammatory responses (such as severe allergic response or ASTHMA) or to prevent rejection after organ transplant. Common exogenous corticosteroids include betamethasone, cortisone, dexamethasone, hydrocortisone, methylprednisolone, prednisolone, prednisone, and triamcinolone. Because corticos- teroids suppress the immune system, people taking them are more susceptible to infections.
See also ANABOLIC STEROIDS; IMMUNOTHERAPY. cosmetic surgery See PLASTIC SURGERY.
Cowper’s glands A pair of pea-sized glands, located one on each side of the urethra at the base of the PROSTATE GLAND, that produce pre-ejaculate (the fluid that lubricates the urethra in advance of ejaculation). They also are called the bulbourethral glands. Cysts occasionally form in the ducts of the Cowper’s glands, creating a sensation of lower pelvic pressure or discomfort. Sometimes the doctor can feel a Cowper’s gland cyst on DIGITAL RECTAL
EXAMINATION (DRE) and will recommend further
evaluation to rule out prostate cancer. See also REPRODUCTIVE SYSTEM.
COX-2 inhibitor See NONSTEROIDAL ANTI-
INFLAMMATORY DRUGS.
Crohn’s disease An inflammatory disorder that most commonly affects the small intestine, though it can affect any part of the digestive tract. The inflammation of Crohn’s disease penetrates the full depth of the intestinal wall, activating nerves in the exterior layers to cause pain and disrupting the functions of the cells of the inner layer to cause fre- quent diarrhea. The cause of Crohn’s disease is unknown, though doctors believe there is an autoimmune or immune system dysfunction com- ponent. Crohn’s disease affects men and women equally and can develop at any age. It is a chronic condition that for most people alternates periods of remission and periods of flare-ups.
The primary symptoms are abdominal pain and chronic diarrhea, and sometimes rectal bleeding or unexplained weight loss. The diagnostic process typically includes barium contrast X-rays of the upper gastrointestinal system in which barium is allowed to flow into the small intestine (often called an upper GI series with small bowel follow- through) and a computed tomography (CT) scan of the abdomen. When there is rectal bleeding or to rule out other possible causes for symptoms, a
COLONOSCOPY, is performed in which the doctor
visually examines the lower gastrointestinal tract (bowel and rectum) using a lighted, flexible scope. Though there are no definitive diagnostic markers for Crohn’s disease, the pattern of inflammation, which affects some areas of the bowel and skips others, is uniquely characteristic.
The inflammation and resulting diarrhea of Crohn’s disease prevents the body from absorbing nutrients through the small intestine. Extended flare-ups of symptoms often result in nutritional deficiencies and weight loss. Treatment targets reducing and controlling the inflammation, and restoring the body’s nutritional balance through appropriate supplements. The medications most commonly used to control inflammation belong to a family of drugs called 5-aminosalicylic acid (5-ASA) agents; they release the substance mesalamine, which appears to act on the intestinal lining to soothe the irritation and reduce the inflammation. Commonly prescribed 5-ASA med- ications include sulfasalazine (Asacol), olsalazine (Dipentum), and mesalamine (Pentasa). A differ- ent kind of drug, infliximab (Remicade), contains a substance called anti-tumor necrosis factor (anti- TNF). TNF is a protein that causes inflammation and irritation; infliximab inactivates TNF in the bloodstream. Corticosteroid medications also can reduce inflammation, though their long-term use has numerous side effects and complications, so doctors generally prescribe them when other med- ications do not work. Medications to control diarrhea, such as loperamide (Imodium) and diph- enoxylate (Lomotil), and ANTIBIOTICS to fight sec- ondary bacterial infections that commonly occur as a result of the inflammation are also among the pharmacological treatment arsenal for Crohn’s dis- ease. Severe inflammation can cause ulcerations
and fistulas that penetrate other body structures such as the rectum. Surgery is necessary to repair these complications and sometimes to remove a section of small intestine that becomes badly scarred from the recurrent inflammation.
Nonmedical therapies do not seem especially helpful for most people with Crohn’s disease.
ACUPUNCTURE can sometimes provide relief from
pain. Dietary items such as spicy foods and alcohol can exacerbate symptoms, as can cigarette smoking. Some doctors treat food allergies or sensitivities as a way of improving Crohn’s disease symptoms, but, in general, diet treatments only have irregular success. Health experts encourage people with Crohn’s disease to follow a nutritionally balanced diet to maintain overall optimal health. Because nutrient depletion that can occur during flare-ups and the body requires certain nutrients, particularly folic acid and vitamin E, to heal the intestinal lining tissues, it is prudent to take nutritional supplements routinely with Crohn’s disease, even during remis- sions. Many people with Crohn’s disease benefit from learning coping skills to manage the disrup- tions of flare-ups and from support groups that can provide shared experiences, compassion, and encouragement.
See also IRRITABLE BOWEL SYNDROME; ULCERATIVE
COLITIS.
cryptorchidism A condition in which an infant is born with a TESTICLEthat fails to descend from the
abdomen into the scrotum (often called an unde- scended testicle). The word means “hidden testi- cle.” Cryptorchidism can be bilateral (involve both testicles) or unilateral (involve one testicle or the other). About half the time, cryptorchidism resolves on its own with the testicle descending into the scrotum by the time the boy is two years old. The testicles develop within the abdomen of the fetus. At about 36 weeks gestational age, hor- monal changes in the mother’s body and in the fetus’s body cause the testicles to drop into their normal positions in the scrotum. About 10 percent of boys born prematurely have cryptorchidism; the earlier the gestational age at birth, the more likely it is for one or both testicles to remain in the abdomen. An undescended testicle cannot produce
SPERMand carries a significant risk for developing
TESTICULAR CANCER. Treatment is to surgically lower the testicle into the scrotum if it fails to descend on its own by age two or three. In most circumstances, there is then no interference with sperm produc- tion or fertility. A man born with an undescended testicle does have a lifelong increased risk for testicular cancer, however, and should regularly
do TESTICULAR SELF-EXAMINATION beginning in
adolescence.
See also FERTILITY.
cryotherapy A therapeutic method that freezes cells or tissues, causing them to die. Doctors commonly use cryotherapy, sometimes called cryosurgery, to remove ACTINIC KERATOSISand basal cell SKIN CANCERlesions, to treat small primary or
metastatic CANCERtumors, and to cause cell death in areas where just a few cells need to be targeted or that are inaccessible to other surgical interven- tions. In cryotherapy the doctor guides a hollow, needlelike probe to the area and releases a gas such as argon, nitrogen, or carbon dioxide maintained at a super-chilled temperature. Irreparable damage occurs to the cells when they thaw after the freez- ing, and over the course of a few days to a few weeks they die and are either sloughed off (on skin surfaces) or processed as waste to be removed from the body. For skin lesions, the doctor may apply the gas in the form of a spray. Dermatologists often perform cryotherapy as an outpatient procedure done in the office; it generally is quick and causes little discomfort. Other cryotherapy applications are more extensive and are done in day surgery facilities or may require an overnight stay in the hospital. Cryotherapy is a treatment option for some prostate cancers. Although it is highly effec- tive at destroying the cancer cells, cryotherapy for
PROSTATE CANCER nearly always also destroys the
nerves that control erection, causing permanent
ERECTILE DYSFUNCTION(impotence).
See also CHEMOTHERAPY; RADIATION THERAPY. curettage and electrodesiccation A treatment to remove basal cell SKIN CANCERin which the derma- tologist uses a slender, somewhat spoon-shaped bladed instrument to scrape the cancer cells from the surface of the skin and then applies a mild elec- trical current to kill any remaining cells. There
generally is little discomfort during or after the procedure.
See also CHEMOTHERAPY; RADIATION THERAPY. Cushing’s syndrome A rare disorder in which there is too much of the hormone cortisol in the body. Cushing’s syndrome is less common in men than in women and develops either as a dysfunc- tion of the endocrine system in which the pituitary gland produces too much ADRENOCORTICOTROPIC
HORMONE (ACTH), which in turn stimulates the
ADRENAL GLANDSto produce cortisol, or from long-
term use of CORTICOSTEROID medications such as prednisone taken to treat ASTHMA or as immuno- suppressive therapy after organ transplant. The most frequent cause of ACTH overproduction are pituitary ADENOMAS, benign tumors of the pituitary gland. The tumors of LUNG CANCER also produce ACTH; this is the form of Cushing’s syndrome most common in men. Characteristic symptoms of Cushing’s syndrome include a “moon” or full and rounded face, a pad of accumulated fat across the shoulders, general obesity, excessive hair growth, muscle weakness, and INFERTILITY and diminished
LIBIDO(sex drive).
Cortisol is part of the body’s “fight or flight” sys- tem. After adrenaline (epinephrine) stimulates heart rate, increases the contractility of skeletal muscles in readiness for rapid response, and ele- vates the blood pressure, the adrenal glands release cortisol. This continues the process, bringing glu- cose into the bloodstream, suppressing inflamma- tion and healing in the body, and promoting blood clotting. The body cannot sustain this state of emer- gency preparedness for extended times, however, and numerous health conditions begin to develop, including HYPERTENSION (high blood pressure),
INSULIN RESISTANCE, type 2 DIABETES, OSTEOPOROSIS,
HYPERLIPIDEMIA, and IMMUNE SYSTEM dysfunction
that results in delayed healing and increased sus- ceptibility to infection.
Laboratory tests that measure the body’s response to administration of corticosteroids and the levels of cortisol in the urine and blood are the primary diagnostic procedures. Imaging examina- tions such as MAGNETIC RESONANCE IMAGING (MRI) or a COMPUTED TOMOGRAPHY(CT) SCANmight be done when the doctor suspects a pituitary or adrenal Cushing’s syndrome 103
tumor. Treatment targets the cause of the cortisol overexposure. In people who must continue immunosuppressive therapy, treatment becomes a balance between undesired side effects and main- taining adequate immunosuppression. Treatment also targets consequential health problems such as hypertension and diabetes.
A serious and potentially life-threatening com- plication of Cushing’s syndrome is adrenal crisis, characterized by HYPOTENSION(low blood pressure), electrolyte imbalances that affect heart rate and rhythm, and mental confusion. Adrenal crisis occurs when there is an abrupt drop in the level of cortisol, typically brought on by an acute stress to the body such as serious illness or injury that requires the body to initiate its stress response. Because this response has become dysfunctional, the mechanisms to increase cortisol production fail. Treatment for adrenal crisis is prompt admin- istration of corticosteroids.
See also ADDISON’S DISEASE.
cyst A benign, fluid-filled growth. Cysts are com- mon and can grow in nearly any body tissue. They often develop as a protective response to repeti- tious injury, such as repeated friction across liga- ments. Cysts can become painful when they press against nerves or other structures, or impede movement or other body functions. A BAKER’S CYST, for example, which arises from the ligaments at the back of the knee, often becomes irritated and causes pain when the knee bends. Sebaceous cysts arise from inflamed hair follicles and can become infected. Some cysts reabsorb and require no med- ical intervention; for others the doctor might use a needle and syringe to drain the fluid or a surgical procedure to remove the intact cyst.
cystitis Inflammation or INFECTIONof the urinary
bladder. Cystitis is much less common in men than in women. When cystitis does occur in a man, generally it is a bacterial infection linked with SEX-
UALLY TRANSMITTED DISEASES (STDS) (more com-
mon in younger men) or PROSTATITIS(infection of
the PROSTATE GLAND, more common in older men).
Cystitis sometimes occurs following the placement or removal of a urinary catheter, or in association with a kidney infection (nephritis). In interstitial
cystitis, a CHRONIC condition characterized by symptoms of bladder irritation and urinary fre- quency, there is inflammation without infection. Diagnosis of cystitis involves laboratory examina- tion of a urine sample (a midstream “clean catch” or catheter-drawn sample) to detect bacteria, white blood cells, and red blood cells. When these are present, the cause of the cystitis is bacterial infec- tion and the treatment is oral antibiotics. When the diagnosis points to interstitial cystitis, treat- ment targets symptoms such as pain and urinary